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General NPI Number Information
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NPI Number | 1225631781
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Entity Type | Individual
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Provider Name | ANGELA BRUCE WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 295 FOREST AVE
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City | PORTLAND
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State | ME
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Zip | 04101-2018
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Country | US
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Telephone | 207-885-2098
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Fax |
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Provider Business Mailing Address
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Address Line | 5 NORTHLEDGE TER
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City | FALMOUTH
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State | ME
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Zip | 04105-2819
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Country | US
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Telephone | 207-233-5460
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PR4980
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License Number State | ME
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