Provider Demographics
NPI:1306920731
Name:BRADFORD, JACELYN TAYLOR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JACELYN
Middle Name:TAYLOR
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4030
Mailing Address - Street 2:W. WASHINGTON STREET
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-0030
Mailing Address - Country:US
Mailing Address - Phone:804-524-7346
Mailing Address - Fax:804-524-4718
Practice Address - Street 1:HIRAM W. DAVIS MEDICAL CENTER PHARMACY
Practice Address - Street 2:W. WASHINGTON STREET
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-0030
Practice Address - Country:US
Practice Address - Phone:804-524-7346
Practice Address - Fax:804-524-4718
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0202205891183500000X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric