Provider Demographics
NPI:1760526172
Name:BRADLEY, THOMAS GEORGE JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GEORGE
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CARTER MOIR DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2965
Mailing Address - Country:US
Mailing Address - Phone:717-569-7838
Mailing Address - Fax:
Practice Address - Street 1:208 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2730
Practice Address - Country:US
Practice Address - Phone:717-393-9811
Practice Address - Fax:717-393-9843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028380L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist