Provider Demographics
NPI:1790359834
Name:PRATHER, BRADLEY WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WAYNE
Last Name:PRATHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:WAYNE
Other - Last Name:PRATHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:600 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2828
Mailing Address - Country:US
Mailing Address - Phone:330-633-2200
Mailing Address - Fax:330-633-9910
Practice Address - Street 1:600 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2828
Practice Address - Country:US
Practice Address - Phone:330-633-2200
Practice Address - Fax:330-633-9910
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03216802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist