Healthcare Provider Details

I. General information

NPI: 1295721819
Provider Name (Legal Business Name): ANGELA R VINTI PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/21/2022
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21810 WILLAMETTE DR UNIT 200
WEST LINN OR
97068-3256
US

IV. Provider business mailing address

21810 WILLAMETTE DR UNIT 200
WEST LINN OR
97068-3256
US

V. Phone/Fax

Practice location:
  • Phone: 503-994-4353
  • Fax:
Mailing address:
  • Phone: 503-994-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number049658
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number15712
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number440607
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16976
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0012872
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number60991746
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number0012872
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: