Provider Demographics
NPI:1942553201
Name:EDGE, ANGELA DAWN (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:EDGE
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 1:2541 CHAPPEREL DR SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6245
Mailing Address - Country:US
Mailing Address - Phone:360-753-6656
Mailing Address - Fax:
Practice Address - Street 1:2541 CHAPPEREL DR SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-6245
Practice Address - Country:US
Practice Address - Phone:360-753-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00057216183500000X
ORRPH-0010130183500000X
MSE-08844183500000X
WAMA 00019814225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist