Healthcare Provider Details

I. General information

NPI: 1801322342
Provider Name (Legal Business Name): ANGELA KREUTER PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E BROAD ST
PATASKALA OH
43062-9551
US

IV. Provider business mailing address

350 E BROAD ST
PATASKALA OH
43062-9551
US

V. Phone/Fax

Practice location:
  • Phone: 740-964-5105
  • Fax: 740-964-5107
Mailing address:
  • Phone: 740-964-5105
  • Fax: 740-964-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03228197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: