Provider Demographics
NPI:1740880368
Name:ENGELBERTH, ANGELA SUSANNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUSANNE
Last Name:ENGELBERTH
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 1:1119 CLEARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3904
Mailing Address - Country:US
Mailing Address - Phone:812-827-1508
Mailing Address - Fax:
Practice Address - Street 1:4040 N NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2575
Practice Address - Country:US
Practice Address - Phone:812-634-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022323A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist