Provider Demographics
NPI:1437434941
Name:BRADSHAW, JENNIFER NASHAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NASHAY
Last Name:BRADSHAW
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 1:19935 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2909
Mailing Address - Country:US
Mailing Address - Phone:305-653-7852
Mailing Address - Fax:305-653-6745
Practice Address - Street 1:19935 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2909
Practice Address - Country:US
Practice Address - Phone:305-653-7852
Practice Address - Fax:305-653-6745
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist