Provider Demographics
NPI:1659718971
Name:BAZALDUA, ANGELA KLAIRE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KLAIRE
Last Name:BAZALDUA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4005
Mailing Address - Country:US
Mailing Address - Phone:806-584-0291
Mailing Address - Fax:806-418-8571
Practice Address - Street 1:1616 S KENTUCKY ST STE A140
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-5215
Practice Address - Country:US
Practice Address - Phone:806-418-8568
Practice Address - Fax:806-418-8571
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX494601835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric