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NPI Code Detail

MEDICARE: DR. ANGELA T CHAMPION PHARMD

MEDICARE: DR. ANGELA T CHAMPION PHARMD
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
1183500000XPharmacist117662MN

General Provider Information

NPI Number : 1689950677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA T CHAMPION PHARMD
Provider Business Mailing Address
First Line : 3240 W LAKE ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55416-4512
Country : US
Telephone Number : 612-922-8436
Fax Number :
Provider Business Practice Location Address
First Line : 4200 WINNETKA AVE N
Second Line :
City : NEW HOPE
State : MN
Zip : 55428-4925
Country : US
Telephone Number : 763-545-6466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2011
Last Update Date : 10/23/2011

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