Provider Demographics
NPI:1174125728
Name:ANGELES, PEDRO (RPH)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:ANGELES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TRUE PL # 1A
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2206
Mailing Address - Country:US
Mailing Address - Phone:617-981-1276
Mailing Address - Fax:
Practice Address - Street 1:405 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3435
Practice Address - Country:US
Practice Address - Phone:617-389-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist