Provider Demographics
NPI:1477667673
Name:WHATLEY, ANGELA S (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:S
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 COUNTY ROAD 4781
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023-5430
Mailing Address - Country:US
Mailing Address - Phone:940-399-8577
Mailing Address - Fax:
Practice Address - Street 1:1026 HALSELL ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-3030
Practice Address - Country:US
Practice Address - Phone:940-683-2950
Practice Address - Fax:940-683-8059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290101040752404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125962OtherCPHT