Provider Demographics
NPI:1710465737
Name:VAN HEEMSTEDE OBELT, ANGELICA PHILLIPS (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:PHILLIPS
Last Name:VAN HEEMSTEDE OBELT
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:KARENA
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 FORUM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7938
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:523 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8210
Practice Address - Country:US
Practice Address - Phone:423-926-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37851183500000X
TN46676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist