Provider Demographics
NPI:1467559534
Name:WAHLE, ANGELA JOY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:WAHLE
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 1:18770 238TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-7511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1826
Practice Address - Country:US
Practice Address - Phone:712-527-4006
Practice Address - Fax:712-527-4113
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12569183500000X
IA20522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist