MEDICARE: DR. ANGELA DENISE GOSSAGE PHARM.D.

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
1	183500000X	Pharmacist	11570	KY

General Provider Information

NPI Number	:	1437288560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA DENISE GOSSAGE PHARM.D.

Provider Business Mailing Address
First Line	:	185 S HIGHWAY 127
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4268
Country	:	US
Telephone Number	:	606-387-0023
Fax Number	:	606-387-0024

Provider Business Practice Location Address
First Line	:	185 S HIGHWAY 127
Second Line	:
City	:	RUSSELL SPRINGS
State	:	KY
Zip	:	42642-4268
Country	:	US
Telephone Number	:	606-387-0023
Fax Number	:	606-387-0024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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