Provider Demographics
NPI:1649611518
Name:PEIGHTAL, ANGELA ROSE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ROSE
Last Name:PEIGHTAL
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 1:315 W BUTLER RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-2531
Mailing Address - Country:US
Mailing Address - Phone:864-288-1847
Mailing Address - Fax:
Practice Address - Street 1:315 W BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2531
Practice Address - Country:US
Practice Address - Phone:864-288-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19650183500000X
SC12219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12219OtherSTATE PHARMACIST LICENSE NUMBER
MD19650OtherPHARMACIST STATE LICENSE NUMBER