Provider Demographics
NPI:1275257727
Name:JENNINGS, BRADLEY (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:299 HAMPTON PARK
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5720
Mailing Address - Country:US
Mailing Address - Phone:614-439-0274
Mailing Address - Fax:
Practice Address - Street 1:5445 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1129
Practice Address - Country:US
Practice Address - Phone:614-844-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03125944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist