Provider Demographics
NPI:1811422710
Name:ANGLES, JUSTIN (PHARMD, BSPS, RPH)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:ANGLES
Suffix:
Gender:M
Credentials:PHARMD, BSPS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4533 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4700
Mailing Address - Country:US
Mailing Address - Phone:419-471-9240
Mailing Address - Fax:419-471-9458
Practice Address - Street 1:4533 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4700
Practice Address - Country:US
Practice Address - Phone:419-471-9240
Practice Address - Fax:419-471-9458
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist