Provider Demographics
NPI:1417074006
Name:ANGELLE GROUP, INC.
Entity Type:Organization
Organization Name:ANGELLE GROUP, INC.
Other - Org Name:PRESCRIPTION COMPOUNDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICEA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:225-766-9577
Mailing Address - Street 1:5302 O'DONOVAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-766-9577
Mailing Address - Fax:
Practice Address - Street 1:5302 O'DONOVAN DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-766-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3904-IR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1194620001Medicare ID - Type Unspecified