Provider Demographics
NPI:1689379125
Name:SMELLEY, ANGELA DAVIS (CPHT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAVIS
Last Name:SMELLEY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1456
Mailing Address - Country:US
Mailing Address - Phone:804-520-4961
Mailing Address - Fax:
Practice Address - Street 1:3210 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1456
Practice Address - Country:US
Practice Address - Phone:804-520-9641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230000560183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician