Provider Demographics
NPI:1891446787
Name:RATLIFF, BRADY BERNARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:BERNARD
Last Name:RATLIFF
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 1:38 MEADOWS EDGE CT
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4482
Mailing Address - Country:US
Mailing Address - Phone:276-494-3005
Mailing Address - Fax:
Practice Address - Street 1:31 E VALLEY DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2822
Practice Address - Country:US
Practice Address - Phone:276-669-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA020220426183500000X
TN45141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN45141OtherTENNESSEE BOARD OF PHARMACY
VA020220426OtherVIRGINIA BOARD OF PHARMACY