Healthcare Provider Details

I. General information

NPI: 1215024286
Provider Name (Legal Business Name): AMY HELEN BRADLEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EAST AVE
ALBION NY
14411-1613
US

IV. Provider business mailing address

4534 MAIN ST
GASPORT NY
14067-9521
US

V. Phone/Fax

Practice location:
  • Phone: 585-589-5639
  • Fax: 585-589-5898
Mailing address:
  • Phone: 716-772-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number034901-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: