Provider Demographics
NPI:1659093862
Name:RADU, PATRICIA MAGGIE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAGGIE
Last Name:RADU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 ADVANCEMENT AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6464
Mailing Address - Country:US
Mailing Address - Phone:814-602-1989
Mailing Address - Fax:
Practice Address - Street 1:1109 W NC HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5548
Practice Address - Country:US
Practice Address - Phone:919-403-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist