Provider Demographics
NPI:1891326112
Name:ANGLE, PRASANNA
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:
Last Name:ANGLE
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 1:39088 WILTON CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2343
Mailing Address - Country:US
Mailing Address - Phone:248-977-6025
Mailing Address - Fax:401-652-2212
Practice Address - Street 1:4901 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3903
Practice Address - Country:US
Practice Address - Phone:248-977-6025
Practice Address - Fax:401-652-2212
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist