Provider Demographics
NPI:1467743740
Name:BRADLEY, JOHN R (PHARM D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 SAINT JOSEPH ST
Mailing Address - Street 2:APT #204
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3677
Mailing Address - Country:US
Mailing Address - Phone:318-282-0478
Mailing Address - Fax:
Practice Address - Street 1:2669 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6409
Practice Address - Country:US
Practice Address - Phone:504-827-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist