Provider Demographics
NPI:1265896062
Name:MEADOWS, ANGELA STUEBEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:STUEBEN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:THERESE
Other - Last Name:STUEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:930 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2010
Mailing Address - Country:US
Mailing Address - Phone:864-608-1527
Mailing Address - Fax:
Practice Address - Street 1:930 NE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2010
Practice Address - Country:US
Practice Address - Phone:864-963-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist