Provider Demographics
NPI:1497117220
Name:BRADLEY, ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
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 1:2946 ISLAND AVE
Mailing Address - Street 2:SHOPRITE PHARMACY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-2026
Mailing Address - Country:US
Mailing Address - Phone:215-937-0327
Mailing Address - Fax:215-492-1835
Practice Address - Street 1:2946 ISLAND AVE
Practice Address - Street 2:SHOPRITE PHARMACY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2026
Practice Address - Country:US
Practice Address - Phone:215-937-0327
Practice Address - Fax:215-492-1835
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446689183500000X
PARPI006830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist