Provider Demographics
NPI:1013218668
Name:BRADBURY, SUZANNE ELISE (PHARMD07/04/1972)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELISE
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PHARMD07/04/1972
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 MURPHY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2656
Mailing Address - Country:US
Mailing Address - Phone:858-292-4148
Mailing Address - Fax:858-292-5071
Practice Address - Street 1:3550 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2656
Practice Address - Country:US
Practice Address - Phone:858-292-4148
Practice Address - Fax:858-292-5071
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist