Provider Demographics
NPI:1902943640
Name:MOORE, ANGELA BARNES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:BARNES
Last Name:MOORE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3448
Mailing Address - Country:US
Mailing Address - Phone:334-756-2037
Mailing Address - Fax:334-756-9024
Practice Address - Street 1:4103 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3448
Practice Address - Country:US
Practice Address - Phone:334-756-2037
Practice Address - Fax:334-756-9024
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-06-16
Deactivation Date:2012-05-29
Deactivation Code:
Reactivation Date:2020-06-09
Provider Licenses
StateLicense IDTaxonomies
AL12288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist