Provider Demographics
NPI:1295912160
Name:GENET, ANGELA MARIE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:GENET
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 1:21325 E MORELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2909
Mailing Address - Country:US
Mailing Address - Phone:262-798-0223
Mailing Address - Fax:262-798-0467
Practice Address - Street 1:21325 E MORELAND BLVD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2909
Practice Address - Country:US
Practice Address - Phone:262-798-0223
Practice Address - Fax:262-798-0467
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14721-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist