Healthcare Provider Details

I. General information

NPI: 1932245347
Provider Name (Legal Business Name): BRADLEY EUGENE BERLEKAMP RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8264 W STATE ROUTE 41
COVINGTON OH
45318-1248
US

IV. Provider business mailing address

1301 PORT JEFFERSON RD
SIDNEY OH
45365-2054
US

V. Phone/Fax

Practice location:
  • Phone: 937-473-3333
  • Fax:
Mailing address:
  • Phone: 937-726-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number03-2-15113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: