Provider Demographics
NPI:1811988140
Name:BRADSHAW, BRIAN D (RPH)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 N MESTER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8089
Mailing Address - Country:US
Mailing Address - Phone:813-263-6610
Mailing Address - Fax:
Practice Address - Street 1:3303 N MESTER ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-8089
Practice Address - Country:US
Practice Address - Phone:813-263-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS204721835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy