Provider Demographics
NPI:1063794592
Name:BRADLEY, TAMMY (RPH)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:BRADLEY
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 1:12802 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34610-4812
Mailing Address - Country:US
Mailing Address - Phone:813-727-0943
Mailing Address - Fax:
Practice Address - Street 1:7827 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-5706
Practice Address - Country:US
Practice Address - Phone:813-528-4093
Practice Address - Fax:813-996-0075
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist