Provider Demographics
NPI:1417369422
Name:BRADLEY, ALISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 FOLLY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2594
Mailing Address - Country:US
Mailing Address - Phone:843-501-9500
Mailing Address - Fax:
Practice Address - Street 1:354 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2594
Practice Address - Country:US
Practice Address - Phone:843-501-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-25
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist