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NPI Code Detail

MEDICARE: ANGELINE AGNES CASTEEL C.PH.T

MEDICARE: ANGELINE AGNES CASTEEL C.PH.T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy Technician0000020357TN

General Provider Information

NPI Number : 1407132947
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELINE AGNES CASTEEL C.PH.T
Provider Business Mailing Address
First Line : 112 WILL DR
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-4407
Country : US
Telephone Number : 931-332-6710
Fax Number : 931-722-9495
Provider Business Practice Location Address
First Line : 215 DEXTER L WOODS MEMORIAL BLVD
Second Line :
City : WAYNESBORO
State : TN
Zip : 38485-2416
Country : US
Telephone Number : 931-722-5466
Fax Number : 931-722-9495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2011
Last Update Date : 10/28/2011

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