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General NPI Number Information
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NPI Number | 1457355950
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Entity Type | Organization
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Legal Business Name | JAMES R BRADFORD
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 104 HUDGINS ST
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City | ESTILL SPRINGS
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State | TN
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Zip | 37330-3027
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Country | US
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Telephone | 931-649-5050
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Fax | 931-649-3148
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Provider Business Mailing Address
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Address Line | 104 HUDGINS ST
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City | ESTILL SPRINGS
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State | TN
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Zip | 37330-3027
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Country | US
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Telephone | 931-649-5050
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Fax | 931-649-3148
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Authorized Official
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Title or Position | OWNER
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Name | JAMES BRADFRORD
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Credential |
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Telephone | 931-649-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | TN3094
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License Number State | TN
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