Provider Demographics
NPI:1023222163
Name:RASMUSSEN, BRADLEY J (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 WINDING RIVER WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2917
Mailing Address - Country:US
Mailing Address - Phone:901-747-0349
Mailing Address - Fax:
Practice Address - Street 1:2525 HORIZON LAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8119
Practice Address - Country:US
Practice Address - Phone:901-248-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10314183500000X
TN27461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist