Provider Demographics
NPI:1528375086
Name:LABERGE, ANGELIQUE C (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:C
Last Name:LABERGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-2147
Mailing Address - Country:US
Mailing Address - Phone:508-678-9066
Mailing Address - Fax:508-677-2931
Practice Address - Street 1:510 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-2147
Practice Address - Country:US
Practice Address - Phone:508-678-9066
Practice Address - Fax:508-677-2931
Is Sole Proprietor?:No
Enumeration Date:2010-09-04
Last Update Date:2010-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist