Provider Demographics
NPI:1063015048
Name:DEHOFF, BRADLEY RICHARD
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:RICHARD
Last Name:DEHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NATURAL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7502
Mailing Address - Country:US
Mailing Address - Phone:717-337-0585
Mailing Address - Fax:
Practice Address - Street 1:44 NATURAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7502
Practice Address - Country:US
Practice Address - Phone:717-337-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP030952L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist