=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225212764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRADLEY CRAIG HOFFMAN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2007
-----------------------------------------------------
Last Update Date | 09/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 LIELMANIS AVE 1ST SOMDG
-----------------------------------------------------
City | HURLBURT FIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32544-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-881-2133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 LIELMANIS AVE 1ST SOMDG
-----------------------------------------------------
City | HURLBURT FIELD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32544-5613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-881-2133
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP442339
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051297175
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------