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General NPI Number Information
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NPI Number | 1528685864
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Entity Type | Individual
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Provider Name | BRADLEY EVAN TABAAC RPH
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Gender | Male
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 2258 N FRONT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19133-3714
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Country | US
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Telephone | 215-425-5230
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Fax | 215-425-5594
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Provider Business Mailing Address
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Address Line | 508 LEON CIR
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City | LANGHORNE
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State | PA
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Zip | 19053-1955
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Country | US
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Telephone | 215-869-4242
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Fax | 215-425-5594
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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 | RP032545L
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License Number State | PA
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