Healthcare Provider Details

I. General information

NPI: 1164665568
Provider Name (Legal Business Name): JOHN P. RADOCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 US HIGHWAY 23 S
ALPENA MI
49707-4542
US

IV. Provider business mailing address

9878 US HIGHWAY 23 N
ALPENA MI
49707-8836
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-4630
  • Fax:
Mailing address:
  • Phone: 989-595-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302023694
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: