Provider Demographics
NPI:1417570565
Name:REDONDO, RAIDEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAIDEL
Middle Name:
Last Name:REDONDO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HAMMOND DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-8191
Mailing Address - Country:US
Mailing Address - Phone:770-522-8194
Mailing Address - Fax:
Practice Address - Street 1:1100 HAMMOND DR STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-8191
Practice Address - Country:US
Practice Address - Phone:770-522-8194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist