Provider Demographics
NPI:1003183104
Name:GLADNEY, NADYNE (RPH)
Entity Type:Individual
Prefix:
First Name:NADYNE
Middle Name:
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4328
Mailing Address - Country:US
Mailing Address - Phone:773-928-6770
Mailing Address - Fax:773-928-1692
Practice Address - Street 1:11040 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4328
Practice Address - Country:US
Practice Address - Phone:773-928-6770
Practice Address - Fax:773-928-1692
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist