Provider Demographics
NPI:1053401349
Name:KADUCAK, LOUIS B (RPH)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:B
Last Name:KADUCAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15930 S LEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8800
Mailing Address - Country:US
Mailing Address - Phone:815-474-4767
Mailing Address - Fax:815-436-6275
Practice Address - Street 1:24715 W EAMES ST
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5192
Practice Address - Country:US
Practice Address - Phone:815-467-6090
Practice Address - Fax:815-467-6167
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist