Provider Demographics
NPI:1588798490
Name:BEAN, ANGELA C (RPH CDM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:BEAN
Suffix:
Gender:F
Credentials:RPH CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 COFFEETOWN RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03037-1218
Mailing Address - Country:US
Mailing Address - Phone:603-463-5939
Mailing Address - Fax:603-463-5939
Practice Address - Street 1:104 MILTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03868-8615
Practice Address - Country:US
Practice Address - Phone:603-335-7856
Practice Address - Fax:603-335-5393
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1264183500000X
NC8713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist