Provider Demographics
NPI:1821384165
Name:RADINSKY, HARLAN (BS)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:
Last Name:RADINSKY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 BARGER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2119
Mailing Address - Country:US
Mailing Address - Phone:314-645-5196
Mailing Address - Fax:
Practice Address - Street 1:1412 BARGER PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-2119
Practice Address - Country:US
Practice Address - Phone:314-645-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO025838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist