Provider Demographics
NPI:1619601366
Name:YUSUF, ANGELA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:YUSUF
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3062
Mailing Address - Country:US
Mailing Address - Phone:248-920-3002
Mailing Address - Fax:
Practice Address - Street 1:1580 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2934
Practice Address - Country:US
Practice Address - Phone:970-564-1353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist