Provider Demographics
NPI:1629345996
Name:RADER, PHILIP R (RPH)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:RADER
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 1:5730 TAYCHOPERA RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1020
Mailing Address - Country:US
Mailing Address - Phone:608-233-8590
Mailing Address - Fax:
Practice Address - Street 1:5730 TAYCHOPERA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1020
Practice Address - Country:US
Practice Address - Phone:608-233-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12306-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist