Provider Demographics
NPI:1669736542
Name:ANGELO, JOSEPH TED (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TED
Last Name:ANGELO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9456
Mailing Address - Country:US
Mailing Address - Phone:509-576-6833
Mailing Address - Fax:509-576-6827
Practice Address - Street 1:13898 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8844
Practice Address - Country:US
Practice Address - Phone:360-896-8932
Practice Address - Fax:360-896-8933
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11760183500000X
WAPH000117601835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist