Provider Demographics
NPI:1982315479
Name:RADTKE, ANN KATHLEEN (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHLEEN
Last Name:RADTKE
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 1:1881 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6200
Mailing Address - Country:US
Mailing Address - Phone:507-625-1660
Mailing Address - Fax:607-625-7676
Practice Address - Street 1:1881 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6200
Practice Address - Country:US
Practice Address - Phone:507-625-1660
Practice Address - Fax:607-625-7676
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist