Provider Demographics
NPI:1023245172
Name:MUMFORD, ANGELA COLEMAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:COLEMAN
Last Name:MUMFORD
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 1:816 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-2067
Mailing Address - Country:US
Mailing Address - Phone:919-552-4248
Mailing Address - Fax:919-552-8965
Practice Address - Street 1:816 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2067
Practice Address - Country:US
Practice Address - Phone:919-552-4248
Practice Address - Fax:919-552-8965
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist