Healthcare Provider Details

I. General information

NPI: 1134883895
Provider Name (Legal Business Name): KERI M BRADLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E GLENDALE AVE
PHOENIX AZ
85020-5332
US

IV. Provider business mailing address

6008 W CHARLOTTE DR
GLENDALE AZ
85310-2777
US

V. Phone/Fax

Practice location:
  • Phone: 602-331-0440
  • Fax: 602-331-0434
Mailing address:
  • Phone: 623-204-5119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS025565
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: