Healthcare Provider Details

I. General information

NPI: 1033401104
Provider Name (Legal Business Name): MICHAEL FRANKLIN ANGELONA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST
ANSTED WV
25812
US

IV. Provider business mailing address

PO BOX 799
ANSTED WV
25812-0799
US

V. Phone/Fax

Practice location:
  • Phone: 304-658-4426
  • Fax: 304-658-9129
Mailing address:
  • Phone: 304-658-4426
  • Fax: 304-658-9129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6067
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: