Provider Demographics
NPI:1629118864
Name:CHRISTIANSON, BRADLEY KEVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:KEVIN
Last Name:CHRISTIANSON
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 1:7797 EVERETT WAY
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-4344
Mailing Address - Country:US
Mailing Address - Phone:303-425-4890
Mailing Address - Fax:
Practice Address - Street 1:4200 E 9TH NINTH AVE BOX A027
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-372-6372
Practice Address - Fax:303-372-6686
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11630183500000X
ND3919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist