Provider Demographics
NPI:1164665568
Name:RADOCY, JOHN P
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:RADOCY
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 1:9878 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8836
Mailing Address - Country:US
Mailing Address - Phone:989-595-2355
Mailing Address - Fax:
Practice Address - Street 1:2140 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4542
Practice Address - Country:US
Practice Address - Phone:989-354-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist