Healthcare Provider Details

I. General information

NPI: 1831290832
Provider Name (Legal Business Name): ANGELA K. TREADWAY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 JEROME ST STE 401
FORT WORTH TX
76104-3942
US

IV. Provider business mailing address

5279 HEIGHTSVIEW LN W APT 2215
FORT WORTH TX
76132-5379
US

V. Phone/Fax

Practice location:
  • Phone: 972-948-2660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number38652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: