Provider Demographics
NPI:1235419219
Name:PHILLIPS, BRADLEY M (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S COUNTY FARM RD
Mailing Address - Street 2:T-0838
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4529
Mailing Address - Country:US
Mailing Address - Phone:630-510-1685
Mailing Address - Fax:
Practice Address - Street 1:601 S COUNTY FARM RD
Practice Address - Street 2:T-0838
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4529
Practice Address - Country:US
Practice Address - Phone:630-510-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist