Provider Demographics
NPI:1154661619
Name:ALLEN, BRADLEY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8489 W CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BERKSHIRE
Mailing Address - State:NY
Mailing Address - Zip Code:13736-2807
Mailing Address - Country:US
Mailing Address - Phone:607-972-3207
Mailing Address - Fax:
Practice Address - Street 1:506 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1524
Practice Address - Country:US
Practice Address - Phone:607-972-3207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist