Healthcare Provider Details

I. General information

NPI: 1407132947
Provider Name (Legal Business Name): ANGELINE AGNES CASTEEL C.PH.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DEXTER L WOODS MEMORIAL BLVD
WAYNESBORO TN
38485-2416
US

IV. Provider business mailing address

112 WILL DR
WAYNESBORO TN
38485-4407
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-5466
  • Fax: 931-722-9495
Mailing address:
  • Phone: 931-332-6710
  • Fax: 931-722-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000020357
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: