Healthcare Provider Details

I. General information

NPI: 1760526172
Provider Name (Legal Business Name): THOMAS GEORGE BRADLEY JR. R. PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N LIME ST
LANCASTER PA
17602-2730
US

IV. Provider business mailing address

318 CARTER MOIR DR
LANCASTER PA
17601-2965
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-9811
  • Fax: 717-393-9843
Mailing address:
  • Phone: 717-569-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP028380L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: