Provider Demographics
NPI:1538657812
Name:DEVORE, ANGELA DAWN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:DEVORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7446 FREDERICK PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-1940
Mailing Address - Country:US
Mailing Address - Phone:419-202-3172
Mailing Address - Fax:
Practice Address - Street 1:401 W NORTH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2607
Practice Address - Country:US
Practice Address - Phone:937-324-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist