Provider Demographics
NPI:1801970926
Name:BRADLEY, SHAUNA UPCHURCH (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:UPCHURCH
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 STRATTON WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8722
Mailing Address - Country:US
Mailing Address - Phone:865-694-5029
Mailing Address - Fax:865-934-6775
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-934-6786
Practice Address - Fax:865-934-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7066OtherSTATE PHARMACIST LICENSE