Provider Demographics
NPI:1720748577
Name:MAGNUS, BRADON MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADON
Middle Name:MICHAEL
Last Name:MAGNUS
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 1:855 W WARNER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7267
Mailing Address - Country:US
Mailing Address - Phone:480-813-7762
Mailing Address - Fax:
Practice Address - Street 1:500 S 99TH AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-9700
Practice Address - Country:US
Practice Address - Phone:480-813-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS025591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist