Provider Demographics
NPI:1376827485
Name:SADRNIA, ANGIE
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:
Last Name:SADRNIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MILLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1737
Mailing Address - Country:US
Mailing Address - Phone:248-619-7125
Mailing Address - Fax:
Practice Address - Street 1:1965 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2006
Practice Address - Country:US
Practice Address - Phone:248-526-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist