Provider Demographics
NPI:1871185157
Name:KIRK, BRADLEY KYLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:KYLE
Last Name:KIRK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:DANIELSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30633-0127
Mailing Address - Country:US
Mailing Address - Phone:706-795-0920
Mailing Address - Fax:
Practice Address - Street 1:7 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:DANIELSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30633-7051
Practice Address - Country:US
Practice Address - Phone:706-795-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026102183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist