Provider Demographics
NPI:1124641386
Name:PARADEE, VANESSA ELAINE (PHARM D)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ELAINE
Last Name:PARADEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 REDWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-7745
Mailing Address - Country:US
Mailing Address - Phone:618-910-7600
Mailing Address - Fax:
Practice Address - Street 1:355 REDWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-7745
Practice Address - Country:US
Practice Address - Phone:618-910-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011006347183500000X
IL051.294365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty