Healthcare Provider Details

I. General information

NPI: 1154697399
Provider Name (Legal Business Name): BRADLEY J NEWELL PHARMD, BCACP, BCGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N AMIDON AVE STE 100
WICHITA KS
67203
US

IV. Provider business mailing address

1010 N KANSAS ST STE 2331-B
WICHITA KS
67214-3124
US

V. Phone/Fax

Practice location:
  • Phone: 316-832-9024
  • Fax:
Mailing address:
  • Phone: 316-293-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14359
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number14359
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14359
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: