Provider Demographics
NPI:1710301346
Name:RADKE, VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:
Last Name:RADKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:ANN
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 1ST AVE
Mailing Address - Street 2:PO BOX 37
Mailing Address - City:WESTBROOK
Mailing Address - State:MN
Mailing Address - Zip Code:56183-9500
Mailing Address - Country:US
Mailing Address - Phone:507-274-6114
Mailing Address - Fax:507-274-5688
Practice Address - Street 1:601 1ST AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:MN
Practice Address - Zip Code:56183-9500
Practice Address - Country:US
Practice Address - Phone:507-274-6114
Practice Address - Fax:507-274-5688
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist