Provider Demographics
NPI:1104997733
Name:ESPOSITO, BRAD A (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:A
Last Name:ESPOSITO
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 S MACDILL AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7261
Mailing Address - Country:US
Mailing Address - Phone:813-839-8700
Mailing Address - Fax:813-839-7575
Practice Address - Street 1:2506 S MACDILL AVE
Practice Address - Street 2:STE. A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7261
Practice Address - Country:US
Practice Address - Phone:813-839-8700
Practice Address - Fax:813-839-7575
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30522183500000X
FLPH244343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002127400Medicaid
FL1093047029Medicare NSC