Provider Demographics
NPI:1972941433
Name:NEUKIRCH, BRADLEY EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:EDWARD
Last Name:NEUKIRCH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SANDY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-2120
Mailing Address - Country:US
Mailing Address - Phone:815-226-9578
Mailing Address - Fax:815-226-0228
Practice Address - Street 1:1321 SANDY HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-2120
Practice Address - Country:US
Practice Address - Phone:815-226-9578
Practice Address - Fax:815-226-0228
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051034920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist