Provider Demographics
NPI:1811793078
Name:BRADSHER, IVONNE KENNEDY (PHARMD)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:KENNEDY
Last Name:BRADSHER
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 BRAYDEN PT APT 208
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6557
Mailing Address - Country:US
Mailing Address - Phone:919-408-9078
Mailing Address - Fax:
Practice Address - Street 1:3570 HARTSEL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4165
Practice Address - Country:US
Practice Address - Phone:719-590-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0025092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist