Provider Demographics
NPI:1861462897
Name:DYMOND, BRADLEY N (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:N
Last Name:DYMOND
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 1:1134 LAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-9213
Mailing Address - Country:US
Mailing Address - Phone:801-254-5295
Mailing Address - Fax:
Practice Address - Street 1:1134 LAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-9213
Practice Address - Country:US
Practice Address - Phone:801-254-5295
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT149153-1719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist