Provider Demographics
NPI:1336350685
Name:ARTHUR, BRADLEY JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOHN
Last Name:ARTHUR
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 1:8050 HIGHLAND FARMS DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2504
Mailing Address - Country:US
Mailing Address - Phone:716-639-9677
Mailing Address - Fax:716-876-7464
Practice Address - Street 1:431 TONAWANDA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-2625
Practice Address - Country:US
Practice Address - Phone:716-876-3070
Practice Address - Fax:716-876-7464
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00591864Medicaid
NY00591864Medicaid