Provider Demographics
NPI:1770659229
Name:STOLTZ, BRADLEY PAUL (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:PAUL
Last Name:STOLTZ
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BELFAIR CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8263
Mailing Address - Country:US
Mailing Address - Phone:803-542-7343
Mailing Address - Fax:
Practice Address - Street 1:101 CORPORATE BLVD
Practice Address - Street 2:STE 108
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4665
Practice Address - Country:US
Practice Address - Phone:803-794-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO161051835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear