Healthcare Provider Details

I. General information

NPI: 1457875569
Provider Name (Legal Business Name): BRADLEY KUCERA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 W SR 436
ALTAMONTE SPRINGS FL
32714-3006
US

IV. Provider business mailing address

886 W SR 436
ALTAMONTE SPRINGS FL
32714-3006
US

V. Phone/Fax

Practice location:
  • Phone: 407-618-0036
  • Fax:
Mailing address:
  • Phone: 407-618-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: