Provider Demographics
NPI:1699804021
Name:KADI, RAGHID (RPH)
Entity type:Individual
Prefix:MR
First Name:RAGHID
Middle Name:
Last Name:KADI
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 1:15939 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7845
Mailing Address - Country:US
Mailing Address - Phone:574-273-2690
Mailing Address - Fax:
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 370
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-3501
Practice Address - Country:US
Practice Address - Phone:574-273-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019710A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist