Provider Demographics
NPI:1508015280
Name:BRADLEY, HOLLY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
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 1:224 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-3704
Mailing Address - Country:US
Mailing Address - Phone:319-234-1589
Mailing Address - Fax:319-234-5627
Practice Address - Street 1:224 BYRON AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-3704
Practice Address - Country:US
Practice Address - Phone:319-234-1589
Practice Address - Fax:319-234-5627
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA196971835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist