Healthcare Provider Details

I. General information

NPI: 1285144618
Provider Name (Legal Business Name): ANGELA LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18906 STATE ROUTE 2
MONROE WA
98272-1415
US

IV. Provider business mailing address

20557 RUSTIC VIEW RD SE
MONROE WA
98272-7640
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-0943
  • Fax:
Mailing address:
  • Phone: 425-381-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: