Provider Demographics
NPI:1063156941
Name:EICKHOLT, ANGELA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:EICKHOLT
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 1:1300 GROTHAUSE ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-1327
Mailing Address - Country:US
Mailing Address - Phone:419-236-0798
Mailing Address - Fax:
Practice Address - Street 1:940 ELIDA AVE
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-1784
Practice Address - Country:US
Practice Address - Phone:419-695-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist