Provider Demographics
NPI:1821143371
Name:RADFORD, DAVID BERNIE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BERNIE
Last Name:RADFORD
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 1:2324 KINMERE DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7812
Mailing Address - Country:US
Mailing Address - Phone:704-810-0713
Mailing Address - Fax:
Practice Address - Street 1:1595 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5138
Practice Address - Country:US
Practice Address - Phone:704-865-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC13982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist