Provider Demographics
NPI:1437433406
Name:PECK, ANGELA NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NICOLE
Last Name:PECK
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 1:13060 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8787
Mailing Address - Country:US
Mailing Address - Phone:574-243-5468
Mailing Address - Fax:574-243-5664
Practice Address - Street 1:13060 ADAMS RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8787
Practice Address - Country:US
Practice Address - Phone:574-243-5468
Practice Address - Fax:574-243-5664
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN361924025183500000X
IN26024100A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist