Provider Demographics
NPI:1326121617
Name:PHILLIPS, ANGELA MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:HANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4144
Mailing Address - Country:US
Mailing Address - Phone:517-482-2148
Mailing Address - Fax:
Practice Address - Street 1:915 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1417
Practice Address - Country:US
Practice Address - Phone:517-364-3079
Practice Address - Fax:517-372-4575
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist