Provider Demographics
NPI:1932700846
Name:MOUTON, ANGELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MOUTON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 NORTH FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1124
Mailing Address - Country:US
Mailing Address - Phone:281-999-9963
Mailing Address - Fax:
Practice Address - Street 1:10411 NORTH FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1124
Practice Address - Country:US
Practice Address - Phone:281-999-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist