Provider Demographics
NPI:1275967382
Name:RADANT, GERALD DANA (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:DANA
Last Name:RADANT
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 1:20818 SOLSTICE DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8404
Mailing Address - Country:US
Mailing Address - Phone:541-408-4858
Mailing Address - Fax:
Practice Address - Street 1:60 NE BEND RIVER MALL DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7528
Practice Address - Country:US
Practice Address - Phone:541-385-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist