Provider Demographics
NPI:1285754382
Name:BRADLEY, THOMAS RICHARD (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RICHARD
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 FERNWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49012-9307
Mailing Address - Country:US
Mailing Address - Phone:269-731-5546
Mailing Address - Fax:
Practice Address - Street 1:8900 GULL RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-9310
Practice Address - Country:US
Practice Address - Phone:269-629-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist