Provider Demographics
NPI:1437288560
Name:GOSSAGE, ANGELA DENISE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:DENISE
Last Name:GOSSAGE
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 1:185 S HIGHWAY 127
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4268
Mailing Address - Country:US
Mailing Address - Phone:606-387-0023
Mailing Address - Fax:606-387-0024
Practice Address - Street 1:185 S HIGHWAY 127
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4268
Practice Address - Country:US
Practice Address - Phone:606-387-0023
Practice Address - Fax:606-387-0024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist