Provider Demographics
NPI:1922511005
Name:ANGU, ANTHONY FRU
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRU
Last Name:ANGU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 FINNEGAN WAY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-6831
Mailing Address - Country:US
Mailing Address - Phone:443-735-6138
Mailing Address - Fax:
Practice Address - Street 1:5989 MORGANTON RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1353
Practice Address - Country:US
Practice Address - Phone:910-487-2700
Practice Address - Fax:910-487-3202
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC27488OtherPHARMACIST LICENSE NUMBER