Provider Demographics
NPI:1043985955
Name:RADECHEL, NEVIN WILLIAM
Entity Type:Individual
Prefix:
First Name:NEVIN
Middle Name:WILLIAM
Last Name:RADECHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 EP TRUE PKWY APT 7305
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5221
Mailing Address - Country:US
Mailing Address - Phone:515-402-2284
Mailing Address - Fax:
Practice Address - Street 1:800 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-9716
Practice Address - Country:US
Practice Address - Phone:515-989-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA242103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy