Provider Demographics
NPI:1720363765
Name:ALLEY, BRADLEY SHANNON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SHANNON
Last Name:ALLEY
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 1:606 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3535
Mailing Address - Country:US
Mailing Address - Phone:423-232-1524
Mailing Address - Fax:423-232-1921
Practice Address - Street 1:606 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3535
Practice Address - Country:US
Practice Address - Phone:423-232-1524
Practice Address - Fax:423-232-1921
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist