Provider Demographics
NPI:1124334578
Name:BRADLEY, KALIYA S (RPH)
Entity type:Individual
Prefix:
First Name:KALIYA
Middle Name:S
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 1:15255 GEORGE ONEAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-1559
Mailing Address - Country:US
Mailing Address - Phone:225-752-3710
Mailing Address - Fax:225-753-1148
Practice Address - Street 1:15255 GEORGE ONEAL RD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-1559
Practice Address - Country:US
Practice Address - Phone:225-752-3710
Practice Address - Fax:225-753-1148
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist