Provider Demographics
NPI:1770612335
Name:TYRE, BRADLEY CLEVELAND (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:CLEVELAND
Last Name:TYRE
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 1:529 CLEMENT CIR
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5805
Mailing Address - Country:US
Mailing Address - Phone:912-634-7309
Mailing Address - Fax:
Practice Address - Street 1:2927 DEMERE RD
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1620
Practice Address - Country:US
Practice Address - Phone:912-638-1999
Practice Address - Fax:912-638-2112
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist