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General NPI Number Information
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NPI Number | 1588172100
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Entity Type | Individual
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Provider Name | WESLEY DRENNON BRADFORD PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 979 E 3RD ST STE B-601
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2136
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Country | US
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Telephone | 423-778-5584
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Fax |
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Provider Business Mailing Address
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Address Line | 2629 PLUM NELLY RD
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City | RISING FAWN
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State | GA
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Zip | 30738-4114
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Country | US
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Telephone | 423-762-9582
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 37593
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License Number State | TN
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