Provider Demographics
NPI:1932495009
Name:NELSON, ANGELA JOY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JOY
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LINCOLN AVE SE
Mailing Address - Street 2:T-0930
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56304-0823
Mailing Address - Country:US
Mailing Address - Phone:320-654-0712
Mailing Address - Fax:320-654-0712
Practice Address - Street 1:125 LINCOLN AVE SE
Practice Address - Street 2:T-0930
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-0823
Practice Address - Country:US
Practice Address - Phone:320-654-0712
Practice Address - Fax:320-654-0712
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist