Healthcare Provider Details

I. General information

NPI: 1225789035
Provider Name (Legal Business Name): MEGAN ANGLE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOCKING MALL
LOGAN OH
43138-1082
US

IV. Provider business mailing address

21 HOCKING MALL
LOGAN OH
43138-1082
US

V. Phone/Fax

Practice location:
  • Phone: 740-316-4496
  • Fax:
Mailing address:
  • Phone: 740-216-4496
  • Fax: 740-216-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03439037
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: