Provider Demographics
NPI:1407140908
Name:JOHN, ANGEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:JOHN
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 1:12801 W SUNRISE BLVD
Mailing Address - Street 2:TARGET 0815
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-4020
Mailing Address - Country:US
Mailing Address - Phone:954-846-0716
Mailing Address - Fax:
Practice Address - Street 1:12801 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-4020
Practice Address - Country:US
Practice Address - Phone:954-846-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist