Basic Information
| Provider Information | |||||||||
| NPI: | 1467597328 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | GORDON | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693431110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3082821291 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | EAST HWY 18 | ||||||||
| Address2: | |||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577701201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673048 | ||||||||
| FaxNumber: | 6058673279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11138 | NE | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.