Provider Demographics
NPI:1497054894
Name:MCCAMISH, ANGELA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCAMISH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 S FEDERAL WAY
Mailing Address - Street 2:FRED MEYER PHARMACY
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-424-7533
Mailing Address - Fax:208-424-7527
Practice Address - Street 1:3527 S FEDERAL WAY
Practice Address - Street 2:FRED MEYER PHARMACY
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-5204
Practice Address - Country:US
Practice Address - Phone:208-424-7533
Practice Address - Fax:208-424-7527
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP56181835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist