Provider Demographics
NPI:1972607356
Name:BRADLEY, ALVIN (RPH PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:RPH PHARMACIST
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 596
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:VA
Mailing Address - Zip Code:23890-0596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23890
Practice Address - Country:US
Practice Address - Phone:804-834-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202003780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist