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General NPI Number Information
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NPI Number | 1669195558
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Entity Type | Individual
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Provider Name | BRADLEY SAMUAL WIENER RPH
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Gender | Male
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 3580 N FEDERAL HWY
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-6608
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Country | US
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Telephone | 954-943-3244
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Fax |
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Provider Business Mailing Address
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Address Line | 12861 146TH PL N
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City | WEST PALM BEACH
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State | FL
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Zip | 33418-7934
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Country | US
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Telephone | 561-870-3102
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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 | PS55567
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License Number State | FL
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