Provider Demographics
NPI:1770894693
Name:RADECSKY, HEATHER JEAN (RPH)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JEAN
Last Name:RADECSKY
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 1:82 HAINES ST
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734
Mailing Address - Country:US
Mailing Address - Phone:609-693-3206
Mailing Address - Fax:
Practice Address - Street 1:82 HAINES ST
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2114
Practice Address - Country:US
Practice Address - Phone:609-693-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02697000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist