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NPI Code Detail

MEDICARE: DR. ANGELA H PEGRAM PHARMD, CDE

MEDICARE: DR. ANGELA H PEGRAM PHARMD, CDE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist13118NC

General Provider Information

NPI Number : 1700860582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA H PEGRAM PHARMD, CDE
Provider Business Mailing Address
First Line : PO BOX 1489
Second Line : 301 YADKIN ST
City : ALBEMARLE
State : NC
Zip : 28002-1489
Country : US
Telephone Number : 704-984-4105
Fax Number : 704-983-7846
Provider Business Practice Location Address
First Line : 301 YADKIN ST
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-3441
Country : US
Telephone Number : 704-984-4105
Fax Number : 704-983-7846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 07/08/2007

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