Provider Demographics
NPI:1689074940
Name:BRADHAM, EMILY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:BRADHAM
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 1:600 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-6504
Mailing Address - Country:US
Mailing Address - Phone:910-483-8972
Mailing Address - Fax:910-484-0607
Practice Address - Street 1:600 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-6504
Practice Address - Country:US
Practice Address - Phone:910-483-8972
Practice Address - Fax:910-484-0607
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist