Provider Demographics
NPI:1679173207
Name:GABLE, ANGELA MARIE (RPH, CDE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:GABLE
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2847 CYPRESS COLONY DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1873
Mailing Address - Country:US
Mailing Address - Phone:419-882-3199
Mailing Address - Fax:
Practice Address - Street 1:485 AIRPORT HWY
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8709
Practice Address - Country:US
Practice Address - Phone:419-337-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03323980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist