Provider Demographics
NPI:1083912380
Name:PROGAR, BRADLEY FRANK
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:FRANK
Last Name:PROGAR
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 1:206 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-1911
Mailing Address - Country:US
Mailing Address - Phone:757-867-7710
Mailing Address - Fax:
Practice Address - Street 1:227 FOX HILL RD # 2
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1739
Practice Address - Country:US
Practice Address - Phone:757-851-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist