MEDICARE: MARION BRADLEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PCT.0006934	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558721324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARION BRADLEY RPH

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403-0218
Country	:	US
Telephone Number	:	203-729-4567
Fax Number	:	203-729-4573

Provider Business Practice Location Address
First Line	:	20 N MAIN ST
Second Line	:
City	:	BEACON FALLS
State	:	CT
Zip	:	06403-1131
Country	:	US
Telephone Number	:	203-729-4567
Fax Number	:	203-729-4573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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Directions to “ MARION BRADLEY RPH” Practice Location

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