Healthcare Provider Details

I. General information

NPI: 1356675334
Provider Name (Legal Business Name): ANGELA LOUISE MACK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

425 CROSS ST
SHAFTER CA
93263-2205
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2507
  • Fax:
Mailing address:
  • Phone: 661-746-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number62646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: