Provider Demographics
NPI:1215332002
Name:BRADLEY, NATHAN (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 E FLORIDA AVE
Mailing Address - Street 2:APT 21-206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2845
Mailing Address - Country:US
Mailing Address - Phone:303-913-8884
Mailing Address - Fax:
Practice Address - Street 1:9141 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-6653
Practice Address - Country:US
Practice Address - Phone:720-344-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist