Provider Demographics
NPI:1396498978
Name:RADZ, MARCUS ADAM (PHARMD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:ADAM
Last Name:RADZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13133 N PORT WASHINGTON RD STE 116
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2422
Mailing Address - Country:US
Mailing Address - Phone:262-243-7367
Mailing Address - Fax:262-243-3701
Practice Address - Street 1:13133 N PORT WASHINGTON RD STE 116
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2422
Practice Address - Country:US
Practice Address - Phone:262-243-7367
Practice Address - Fax:262-243-3701
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30421183500000X
WI22045-40183500000X
IL051.303156183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist