Provider Demographics
NPI:1316546625
Name:BRADLEY, HEATHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:PURSCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5942 ROONEY DR
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6793
Mailing Address - Country:US
Mailing Address - Phone:479-659-2642
Mailing Address - Fax:
Practice Address - Street 1:1000 OAKLEAF WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2246
Practice Address - Country:US
Practice Address - Phone:715-895-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19132-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist