Provider Demographics
NPI:1437995537
Name:EDEN, ANGELA LYN
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYN
Last Name:EDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WESTGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:WAKARUSA
Mailing Address - State:IN
Mailing Address - Zip Code:46573-8507
Mailing Address - Country:US
Mailing Address - Phone:574-274-6095
Mailing Address - Fax:
Practice Address - Street 1:900 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3624
Practice Address - Country:US
Practice Address - Phone:574-206-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021795A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist