Provider Demographics
NPI:1538432091
Name:CARNEY, ANGELA CHRISTINE (RPH)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:CHRISTINE
Last Name:CARNEY
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 1:19378 BROOKSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3207
Mailing Address - Country:US
Mailing Address - Phone:541-617-0213
Mailing Address - Fax:541-389-6173
Practice Address - Street 1:351 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-5175
Practice Address - Country:US
Practice Address - Phone:541-389-5610
Practice Address - Fax:541-389-6173
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0008191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist