Provider Demographics
NPI:1609050996
Name:LETTS, J ANGELA
Entity Type:Individual
Prefix:MS
First Name:J
Middle Name:ANGELA
Last Name:LETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-5720
Mailing Address - Country:US
Mailing Address - Phone:914-613-9374
Mailing Address - Fax:
Practice Address - Street 1:321 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-5720
Practice Address - Country:US
Practice Address - Phone:914-613-9374
Practice Address - Fax:914-613-9376
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040995-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01823707Medicaid