Healthcare Provider Details

I. General information

NPI: 1619446028
Provider Name (Legal Business Name): BRADLEY JAMES BUURMA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-4545
US

IV. Provider business mailing address

2585 KNIGHTSBRIDGE RD SE
GRAND RAPIDS MI
49546-6754
US

V. Phone/Fax

Practice location:
  • Phone: 616-447-1510
  • Fax:
Mailing address:
  • Phone: 616-644-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5302042740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: