Provider Demographics
NPI:1427595792
Name:BRADSHAW, CHARLES EVERETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EVERETT
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:CHAD
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:455 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1327
Mailing Address - Country:US
Mailing Address - Phone:626-993-1212
Mailing Address - Fax:626-204-0089
Practice Address - Street 1:455 W MONTANA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1327
Practice Address - Country:US
Practice Address - Phone:626-993-1212
Practice Address - Fax:626-204-0089
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist