Provider Demographics
NPI:1982989547
Name:HAIRSTON, ANGELA CHARLENE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHARLENE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-5508
Mailing Address - Country:US
Mailing Address - Phone:404-284-9912
Mailing Address - Fax:404-284-6710
Practice Address - Street 1:2035 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5508
Practice Address - Country:US
Practice Address - Phone:404-284-9912
Practice Address - Fax:404-284-6710
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist