Healthcare Provider Details

I. General information

NPI: 1235131921
Provider Name (Legal Business Name): BRADLEY RAY SIKORSKI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

961 PIEDMONT AVE NE
ATLANTA GA
30309-4108
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8902
  • Fax:
Mailing address:
  • Phone: 404-547-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019266
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: