Provider Demographics
NPI:1003414905
Name:KADAKIA, VAIBHAV (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VAIBHAV
Middle Name:
Last Name:KADAKIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 PRAIRIEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1826
Mailing Address - Country:US
Mailing Address - Phone:630-802-5279
Mailing Address - Fax:
Practice Address - Street 1:351 S WASHBURN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7932
Practice Address - Country:US
Practice Address - Phone:920-231-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18638-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist