Healthcare Provider Details

I. General information

NPI: 1346235942
Provider Name (Legal Business Name): BRADLEY ROBERT WILLIAMS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

101 THE CITY DR S PAVILION IV
ORANGE CA
92868-3201
US

IV. Provider business mailing address

25101 DORIA AVE
LOMITA CA
90717-1717
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-2800
  • Fax:
Mailing address:
  • Phone: 310-325-1017
  • Fax: 310-325-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH31318
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: