Provider Demographics
NPI:1154151082
Name:BRADFORD, GRACIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GRACIE
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 AUTUMN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:STERRETT
Mailing Address - State:AL
Mailing Address - Zip Code:35147-9224
Mailing Address - Country:US
Mailing Address - Phone:205-876-3700
Mailing Address - Fax:
Practice Address - Street 1:300 CARLOW LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6688
Practice Address - Country:US
Practice Address - Phone:205-713-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist