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General NPI Number Information
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NPI Number | 1760274849
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Entity Type | Individual
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Provider Name | BRADLEY WUTHRICH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 217 S MADISON ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2321
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Country | US
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Telephone | 231-935-6734
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Fax | 231-935-6979
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Provider Business Mailing Address
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Address Line | 1362 BLACK BARK LN
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-8242
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Country | US
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Telephone | 765-744-7846
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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 | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | 5302412582
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License Number State | MI
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