Healthcare Provider Details

I. General information

NPI: 1801370622
Provider Name (Legal Business Name): TYLER JOSHUA BRADLEY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 W GENESEE ST
LAPEER MI
48446-1876
US

IV. Provider business mailing address

1001 S DAYTON ST
DAVISON MI
48423-1741
US

V. Phone/Fax

Practice location:
  • Phone: 810-664-4578
  • Fax:
Mailing address:
  • Phone: 810-280-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302046641
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: