Provider Demographics
NPI:1386622678
Name:BRADLEY, THOMAS A (RPH)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
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 1:10 HEMLOCK LANE
Mailing Address - Street 2:
Mailing Address - City:ELYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17824
Mailing Address - Country:US
Mailing Address - Phone:570-672-9129
Mailing Address - Fax:
Practice Address - Street 1:605 N SHAMOKIN ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872
Practice Address - Country:US
Practice Address - Phone:570-648-5242
Practice Address - Fax:570-648-3606
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030517L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist