Provider Demographics
NPI:1811229727
Name:ANTHONY, BRADLEY JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JOSEPH
Last Name:ANTHONY
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 1:1015 N MAIN RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-2538
Mailing Address - Country:US
Mailing Address - Phone:856-691-1465
Mailing Address - Fax:856-696-3215
Practice Address - Street 1:1015 N MAIN RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-2538
Practice Address - Country:US
Practice Address - Phone:856-691-1465
Practice Address - Fax:856-696-3215
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02569100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist