Provider Demographics
NPI:1285209395
Name:NORRIS, ANGELIQUE DEDE (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:DEDE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HWY 146 SOUTH
Mailing Address - Street 2:B
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571
Mailing Address - Country:US
Mailing Address - Phone:281-842-8500
Mailing Address - Fax:
Practice Address - Street 1:112 HWY 146 SOUTH
Practice Address - Street 2:B
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:281-842-8500
Practice Address - Fax:281-842-8505
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist