Provider Demographics
NPI:1255723193
Name:BRADBURY, AMANDA (PHARM D)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-3910
Mailing Address - Country:US
Mailing Address - Phone:423-344-7106
Mailing Address - Fax:
Practice Address - Street 1:8634 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:TN
Practice Address - Zip Code:37341-3910
Practice Address - Country:US
Practice Address - Phone:423-344-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist