Provider Demographics
NPI:1720478811
Name:KAMENIK, ANGELA M (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:KAMENIK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:WUEBKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1663 STATE ROUTE 603
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8715
Mailing Address - Country:US
Mailing Address - Phone:419-733-4845
Mailing Address - Fax:
Practice Address - Street 1:1025 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4011
Practice Address - Country:US
Practice Address - Phone:419-289-9636
Practice Address - Fax:419-207-2684
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist