Provider Demographics
NPI:1265723811
Name:RADWANSKI, MARIE F (RPH)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:F
Last Name:RADWANSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 PERIVALE PARK RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1219
Mailing Address - Country:US
Mailing Address - Phone:419-843-5893
Mailing Address - Fax:419-843-1134
Practice Address - Street 1:5890 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2200
Practice Address - Country:US
Practice Address - Phone:419-882-5860
Practice Address - Fax:419-882-6153
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03112407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist