Provider Demographics
NPI:1316246804
Name:RADECKI, DENNIS (RPH)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:RADECKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3580
Mailing Address - Country:US
Mailing Address - Phone:419-697-1154
Mailing Address - Fax:
Practice Address - Street 1:2647 WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619
Practice Address - Country:US
Practice Address - Phone:419-693-1310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist