Provider Demographics
NPI:1598891236
Name:BRADISH, SANDRA MCCLURE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MCCLURE
Last Name:BRADISH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 OLD U.S. HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711
Mailing Address - Country:US
Mailing Address - Phone:828-669-3132
Mailing Address - Fax:828-669-3342
Practice Address - Street 1:932 OLD U.S. HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-9426
Practice Address - Country:US
Practice Address - Phone:828-669-3132
Practice Address - Fax:828-669-3342
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist