Provider Demographics
NPI:1043985955
Name:RADECHEL, NEVIN WILLIAM
Entity type:Individual
Prefix:
First Name:NEVIN
Middle Name:WILLIAM
Last Name:RADECHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-2520
Mailing Address - Country:US
Mailing Address - Phone:515-402-2284
Mailing Address - Fax:
Practice Address - Street 1:2804 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-4038
Practice Address - Country:US
Practice Address - Phone:515-277-3702
Practice Address - Fax:515-277-3703
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist