Provider Demographics
NPI:1538317011
Name:BRADLEY, JOHN BROOKS (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BROOKS
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 MACAO CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2129
Mailing Address - Country:US
Mailing Address - Phone:972-596-2533
Mailing Address - Fax:972-596-0361
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-6393
Practice Address - Country:US
Practice Address - Phone:254-288-8800
Practice Address - Fax:254-286-7963
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist