Healthcare Provider Details

I. General information

NPI: 1689113748
Provider Name (Legal Business Name): BRADLEY STEVEN KUHNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W FAYETTE AVE
EFFINGHAM IL
62401-2415
US

IV. Provider business mailing address

805 W FAYETTE AVE
EFFINGHAM IL
62401-2415
US

V. Phone/Fax

Practice location:
  • Phone: 217-343-9393
  • Fax:
Mailing address:
  • Phone: 217-342-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051297759
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: