Provider Demographics
NPI:1881973113
Name:BRADFORD, REBECCA JEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:CALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5262 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3796
Mailing Address - Country:US
Mailing Address - Phone:410-221-2414
Mailing Address - Fax:410-221-2431
Practice Address - Street 1:5262 WOODS RD
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3796
Practice Address - Country:US
Practice Address - Phone:410-221-2414
Practice Address - Fax:410-221-2431
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20595183500000X
VA0202210585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist