Provider Demographics
NPI:1861792525
Name:PREDKELIS, RICHARD D (PHARM D)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:PREDKELIS
Suffix:
Gender:M
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 1:120 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3829
Mailing Address - Country:US
Mailing Address - Phone:630-856-3946
Mailing Address - Fax:630-856-3939
Practice Address - Street 1:120 N OAK ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3829
Practice Address - Country:US
Practice Address - Phone:630-856-3946
Practice Address - Fax:630-856-3939
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051040405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist