Healthcare Provider Details

I. General information

NPI: 1689379125
Provider Name (Legal Business Name): ANGELA DAVIS SMELLEY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 BOULEVARD
COLONIAL HEIGHTS VA
23834-1456
US

IV. Provider business mailing address

3210 BOULEVARD
COLONIAL HEIGHTS VA
23834-1456
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-9641
  • Fax:
Mailing address:
  • Phone: 804-520-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230000560
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: