Provider Demographics
NPI:1740500396
Name:HONNAGE, BRADLEY JOHN (PHARM, D,)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JOHN
Last Name:HONNAGE
Suffix:
Gender:M
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 1:1688 N PERRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-4709
Mailing Address - Country:US
Mailing Address - Phone:951-943-6868
Mailing Address - Fax:951-943-9265
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-943-6868
Practice Address - Fax:951-943-9265
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2010-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist