Provider Demographics
NPI:1891082756
Name:BRADAC, REBECCA LEE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LEE
Last Name:BRADAC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1483
Mailing Address - Country:US
Mailing Address - Phone:740-363-1933
Mailing Address - Fax:740-363-6335
Practice Address - Street 1:800 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1483
Practice Address - Country:US
Practice Address - Phone:740-363-1933
Practice Address - Fax:740-363-6335
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist