Provider Demographics
NPI:1972821429
Name:BRADLEY, KIMBERLY S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-1720
Mailing Address - Country:US
Mailing Address - Phone:662-562-9366
Mailing Address - Fax:662-562-9353
Practice Address - Street 1:5148 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-1720
Practice Address - Country:US
Practice Address - Phone:662-562-9366
Practice Address - Fax:662-562-9353
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist