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General NPI Number Information
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NPI Number | 1487215810
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Entity Type | Individual
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Provider Name | SUSAN KANE BRADLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 77 W BARNEY ST
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City | GOUVERNEUR
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State | NY
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Zip | 13642-1040
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Country | US
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Telephone | 315-535-9243
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Fax |
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Provider Business Mailing Address
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Address Line | 17272 US ROUTE 11
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City | WATERTOWN
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State | NY
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Zip | 13601-5394
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Country | US
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Telephone | 518-588-7383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 059155
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License Number State | NY
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