Provider Demographics
NPI:1578694493
Name:CHERSON, BRAD MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:MICHAEL
Last Name:CHERSON
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 1:5731 BERRYTON CT
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2050
Mailing Address - Country:US
Mailing Address - Phone:770-262-9042
Mailing Address - Fax:678-407-1941
Practice Address - Street 1:5731 BERRYTON CT
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2050
Practice Address - Country:US
Practice Address - Phone:770-262-9042
Practice Address - Fax:678-407-1941
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist