Provider Demographics
NPI:1699078022
Name:BRADLEY, CURTIS LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:LEE
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 1:504 CHINNS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WURTLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1608
Mailing Address - Country:US
Mailing Address - Phone:606-836-2096
Mailing Address - Fax:606-326-0764
Practice Address - Street 1:504 CHINNS BRANCH RD
Practice Address - Street 2:
Practice Address - City:WURTLAND
Practice Address - State:KY
Practice Address - Zip Code:41144-1608
Practice Address - Country:US
Practice Address - Phone:606-836-2096
Practice Address - Fax:606-326-0764
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03320280183500000X
KY011745183500000X
WVRP00006129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist