Provider Demographics
NPI:1578629952
Name:RADHAKRISHNAN, LATHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LATHA
Middle Name:
Last Name:RADHAKRISHNAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S RACINE AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2862
Mailing Address - Country:US
Mailing Address - Phone:773-209-4452
Mailing Address - Fax:
Practice Address - Street 1:833 S WOOD ROOM 164
Practice Address - Street 2:UNIVERSITY OF ILLINOIS, COLLEGE OF PHARMACY MC 886
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-6985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL126125901835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology