Provider Demographics
NPI:1306279906
Name:LOCKHART, BRADLEY D (BS, PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:D
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:BS, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2843
Mailing Address - Street 2:908 S EVERGREEN DRIVE
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935-2843
Mailing Address - Country:US
Mailing Address - Phone:480-204-0951
Mailing Address - Fax:
Practice Address - Street 1:4951 S WHITE MOUNTAIN RD STE 1500
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7801
Practice Address - Country:US
Practice Address - Phone:928-537-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10203183500000X
AZ13489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist