Provider Demographics
NPI:1184112880
Name:BANKS, ANGELA P
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:P
Last Name:BANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-6535
Mailing Address - Country:US
Mailing Address - Phone:931-728-8904
Mailing Address - Fax:931-728-4149
Practice Address - Street 1:2518 HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-6535
Practice Address - Country:US
Practice Address - Phone:931-728-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist