Provider Demographics
NPI:1467627455
Name:DAGEN, BRADLEY KENT JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KENT
Last Name:DAGEN
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N KALAMAZOO MALL
Mailing Address - Street 2:UNIT 202
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5829
Mailing Address - Country:US
Mailing Address - Phone:231-215-1277
Mailing Address - Fax:
Practice Address - Street 1:319 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1426
Practice Address - Country:US
Practice Address - Phone:269-657-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist