Provider Demographics
NPI:1093194037
Name:BRADLEY, KIRSTIN NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:NICOLE
Last Name:BRADLEY
Suffix:
Gender:F
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:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:NC
Mailing Address - Zip Code:27925-0239
Mailing Address - Country:US
Mailing Address - Phone:252-796-2421
Mailing Address - Fax:252-796-1124
Practice Address - Street 1:214 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NC
Practice Address - Zip Code:27925-9717
Practice Address - Country:US
Practice Address - Phone:252-796-2421
Practice Address - Fax:252-796-1124
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist