Provider Demographics
NPI:1982043659
Name:DELICH, ANGELA (RPH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DELICH
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 1:306 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2524
Mailing Address - Country:US
Mailing Address - Phone:218-749-6333
Mailing Address - Fax:
Practice Address - Street 1:306 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2524
Practice Address - Country:US
Practice Address - Phone:218-749-6333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116232183500000X
WI13975040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist