Provider Demographics
NPI:1346510773
Name:OH, ANGIE HAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGIE
Middle Name:HAN
Last Name:OH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5038 W LARIAT LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1853
Mailing Address - Country:US
Mailing Address - Phone:602-318-5155
Mailing Address - Fax:
Practice Address - Street 1:1646 W MONTEBELLO AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2557
Practice Address - Country:US
Practice Address - Phone:602-293-4523
Practice Address - Fax:602-293-4530
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist