Provider Demographics
NPI:1396043105
Name:BRADHAM, JAMES ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:BRADHAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:684 MARSH POINT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9015
Mailing Address - Country:US
Mailing Address - Phone:843-795-1476
Mailing Address - Fax:843-795-9239
Practice Address - Street 1:915 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3907
Practice Address - Country:US
Practice Address - Phone:843-795-5452
Practice Address - Fax:843-795-9239
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist