Provider Demographics
NPI:1730915042
Name:GRADOS, ALICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:GRADOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:REINL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 E RHINE ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53020-1992
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4433 VANGUARD DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-6067
Practice Address - Country:US
Practice Address - Phone:920-459-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22800-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist