Provider Demographics
NPI:1376012161
Name:HOOPER, ANGELIQUE KARIOTIS (RPH)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:KARIOTIS
Last Name:HOOPER
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 1:11927 JERUSALEM RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1147
Mailing Address - Country:US
Mailing Address - Phone:410-592-5260
Mailing Address - Fax:
Practice Address - Street 1:11927 JERUSALEM RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21087-1147
Practice Address - Country:US
Practice Address - Phone:410-592-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist