Provider Demographics
NPI:1134407828
Name:RADOMSKY, CARRIE (PHARMD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RADOMSKY
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 1:11870 E ELIN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-8723
Mailing Address - Country:US
Mailing Address - Phone:520-577-3415
Mailing Address - Fax:
Practice Address - Street 1:6767 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2806
Practice Address - Country:US
Practice Address - Phone:520-290-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist