Provider Demographics
NPI:1841959145
Name:BLY, ANGELA (CPHT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BLY
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1148
Mailing Address - Country:US
Mailing Address - Phone:607-377-4342
Mailing Address - Fax:
Practice Address - Street 1:33 KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1148
Practice Address - Country:US
Practice Address - Phone:607-377-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30166135183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician