Provider Demographics
NPI:1053636076
Name:STURGIS, BRADFORD ROGERS (RPH)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:ROGERS
Last Name:STURGIS
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:36756-0220
Mailing Address - Country:US
Mailing Address - Phone:334-683-6166
Mailing Address - Fax:334-683-9621
Practice Address - Street 1:304 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756-2332
Practice Address - Country:US
Practice Address - Phone:334-683-6166
Practice Address - Fax:334-683-9621
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL9717Medicaid