Provider Demographics
NPI:1245639384
Name:RADER, MICHAEL II (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RADER
Suffix:II
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5318
Mailing Address - Country:US
Mailing Address - Phone:337-238-9041
Mailing Address - Fax:337-238-9323
Practice Address - Street 1:2204 S 5TH ST
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-5318
Practice Address - Country:US
Practice Address - Phone:337-238-9041
Practice Address - Fax:337-238-9323
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020542183500000X
TX44937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist