Provider Demographics
NPI:1215024286
Name:BRADLEY, AMY HELEN (RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HELEN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4534 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9521
Mailing Address - Country:US
Mailing Address - Phone:716-772-7465
Mailing Address - Fax:
Practice Address - Street 1:10 EAST AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1613
Practice Address - Country:US
Practice Address - Phone:585-589-5639
Practice Address - Fax:585-589-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034901-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist