Provider Demographics
NPI:1821466343
Name:VANDYKE, ANGELA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:VANDYKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MALERICH DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-9700
Mailing Address - Country:US
Mailing Address - Phone:217-735-3344
Mailing Address - Fax:
Practice Address - Street 1:825 MALERICH DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:IL
Practice Address - Zip Code:62656-9700
Practice Address - Country:US
Practice Address - Phone:217-735-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294885183500000X
IN26024016A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist