Provider Demographics
NPI:1609969187
Name:BRADLEY, KOURTNEY BRIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KOURTNEY
Middle Name:BRIA
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 1:8187W STATE HIGHWAY M-94
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854
Mailing Address - Country:US
Mailing Address - Phone:906-341-0068
Mailing Address - Fax:
Practice Address - Street 1:5698 W. US-2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-341-9545
Practice Address - Fax:906-341-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist