Provider Demographics
NPI:1851674410
Name:PHILBRICK, BRADLEY G (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:G
Last Name:PHILBRICK
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 1:4005 W KILGORE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4815
Mailing Address - Country:US
Mailing Address - Phone:765-286-6337
Mailing Address - Fax:765-286-0312
Practice Address - Street 1:4005 W KILGORE AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4815
Practice Address - Country:US
Practice Address - Phone:765-286-6337
Practice Address - Fax:765-286-0312
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014189A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist