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General NPI Number Information
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NPI Number | 1891007068
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Entity Type | Individual
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Provider Name | ANGELA REE WACKOWSKI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2010
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Last Update Date | 12/23/2022
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Provider Practice Location Address
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Address Line | 130 W RAVINE RD STE 101
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City | KINGSPORT
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State | TN
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Zip | 37660-3837
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Country | US
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Telephone | 423-224-6860
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Fax | 423-224-5657
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Provider Business Mailing Address
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Address Line | 130 W RAVINE RD STE 101
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City | KINGSPORT
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State | TN
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Zip | 37660-3837
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Country | US
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Telephone | 423-224-6860
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Fax | 423-224-5657
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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 | 16086
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13012
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License Number State | TN
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