Provider Demographics
NPI:1154462208
Name:REIDY, DUANE P (RPH)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:P
Last Name:REIDY
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 1:13556 S TARA DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9170
Mailing Address - Country:US
Mailing Address - Phone:708-301-8125
Mailing Address - Fax:708-478-3418
Practice Address - Street 1:18210 LA GRANGE RD
Practice Address - Street 2:101
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-7722
Practice Address - Country:US
Practice Address - Phone:708-478-3418
Practice Address - Fax:708-478-4743
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist