Provider Demographics
NPI:1053469395
Name:RADEMACHER, JOHN R
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:R
Other - Last Name:RADEMACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPH
Mailing Address - Street 1:1936 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8707
Mailing Address - Country:US
Mailing Address - Phone:865-475-1016
Mailing Address - Fax:
Practice Address - Street 1:925 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3814
Practice Address - Country:US
Practice Address - Phone:423-587-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist