Provider Demographics
NPI:1538360318
Name:RADICK, LORRAINE ESTELLE (RPH,MS)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:ESTELLE
Last Name:RADICK
Suffix:
Gender:F
Credentials:RPH,MS
Other - Prefix:MRS
Other - First Name:LORRAINE
Other - Middle Name:ESTELLE
Other - Last Name:RADICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH,MS
Mailing Address - Street 1:8 KITTANSET ROAD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-622-6960
Mailing Address - Fax:
Practice Address - Street 1:15 MONT VERNON ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4120
Practice Address - Country:US
Practice Address - Phone:603-673-0224
Practice Address - Fax:603-673-7644
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist