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NPI Code Detail

MEDICARE: ROGER RADEKE

MEDICARE: ROGER RADEKE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.028841IL

General Provider Information

NPI Number : 1053691691
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER RADEKE
Provider Business Mailing Address
First Line : 430 BRIERHILL RD
Second Line :
City : DEERFIELD
State : IL
Zip : 60015-4402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9595 GRAND AVE
Second Line :
City : FRANKLIN PARK
State : IL
Zip : 60131-3305
Country : US
Telephone Number : 847-455-6876
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2011
Last Update Date : 08/26/2011

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Directions to “ ROGER RADEKE ” Practice Location

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