Provider Demographics
NPI:1295736718
Name:NORRELL, ANGELICA IVY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:IVY
Last Name:NORRELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7312 CEDAR CREEK LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2377
Mailing Address - Country:US
Mailing Address - Phone:706-332-2289
Mailing Address - Fax:
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-1993
Practice Address - Fax:706-571-1340
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist