Healthcare Provider Details

I. General information

NPI: 1760274849
Provider Name (Legal Business Name): BRADLEY WUTHRICH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S MADISON ST
TRAVERSE CITY MI
49684-2321
US

IV. Provider business mailing address

1362 BLACK BARK LN
TRAVERSE CITY MI
49696-8242
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-6734
  • Fax: 231-935-6979
Mailing address:
  • Phone: 765-744-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number5302412582
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: