Provider Demographics
NPI:1114336831
Name:STUDNICKI, KERRY (RPH)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:STUDNICKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-3931
Mailing Address - Country:US
Mailing Address - Phone:618-462-5386
Mailing Address - Fax:
Practice Address - Street 1:1650 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-3931
Practice Address - Country:US
Practice Address - Phone:618-462-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.296326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist