Healthcare Provider Details

I. General information

NPI: 1588256788
Provider Name (Legal Business Name): BRADLEY S HARGIS CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 MAIN ST
PIKEVILLE TN
37367-5752
US

IV. Provider business mailing address

191 OLD SAMPSON RD
PIKEVILLE TN
37367-6868
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2434
  • Fax: 423-447-6151
Mailing address:
  • Phone: 423-653-6369
  • Fax: 423-447-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number22441
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: