Provider Demographics
NPI:1831584036
Name:BRADSHAW, CHIREEN MICHELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHIREEN
Middle Name:MICHELLE
Last Name:BRADSHAW
Suffix:
Gender:F
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:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:ME
Mailing Address - Zip Code:04667-0351
Mailing Address - Country:US
Mailing Address - Phone:207-853-5052
Mailing Address - Fax:207-853-5053
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-5052
Practice Address - Fax:207-853-5053
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PIN-LIC-28616183500000X
MEPR47203183500000X, 1835P0018X
NDRPH5763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist