MEDICARE: ANGELA ELIZABETH DEMOSS RPH.

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	10529	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598750150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA ELIZABETH DEMOSS RPH.

Provider Business Mailing Address
First Line	:	70 SEMINOLE TRL
Second Line	:
City	:	MOREHEAD
State	:	KY
Zip	:	40351-8370
Country	:	US
Telephone Number	:	606-780-0251
Fax Number	:	859-289-7710

Provider Business Practice Location Address
First Line	:	116 MAIN ST
Second Line	:
City	:	CARLISLE
State	:	KY
Zip	:	40311-1154
Country	:	US
Telephone Number	:	859-289-5122
Fax Number	:	859-289-7710

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/09/2007

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