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General NPI Number Information
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NPI Number | 1639758253
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Entity Type | Individual
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Provider Name | CLAUDIA DIXIE BRADLEY RPH
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 3840 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4416
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Country | US
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Telephone | 253-564-2255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | LAKEBAY
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State | WA
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Zip | 98349-0265
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Country | US
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Telephone | 360-298-6279
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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 | RPH-0006955
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | PH-00021524
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License Number State | WA
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