Healthcare Provider Details

I. General information

NPI: 1588294094
Provider Name (Legal Business Name): BRADLEY JOHN HOFFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5646 OLD FORT JUPITER RD
JUPITER FL
33458-3441
US

IV. Provider business mailing address

5646 OLD FORT JUPITER RD
JUPITER FL
33458-3441
US

V. Phone/Fax

Practice location:
  • Phone: 561-779-0954
  • Fax:
Mailing address:
  • Phone: 561-779-0954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberS12680
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64205
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number40335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: