Healthcare Provider Details

I. General information

NPI: 1376460899
Provider Name (Legal Business Name): BRADLEY ROGERS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

1041 NW 76TH AVE
PLANTATION FL
33322-5142
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-9955
  • Fax: 954-265-9017
Mailing address:
  • Phone: 248-252-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License NumberPS47736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: