Provider Demographics
NPI:1902197296
Name:RICHARDSON, ANGELA K (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 TWIN FAWN TRL
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8547
Mailing Address - Country:US
Mailing Address - Phone:304-834-2114
Mailing Address - Fax:
Practice Address - Street 1:2300 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-1347
Practice Address - Country:US
Practice Address - Phone:304-295-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006184183500000X
OH03225152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist