MEDICARE: DR. MAREN BRADLEY PHARMD, RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-15955	KS

General Provider Information

NPI Number	:	1003661125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAREN BRADLEY PHARMD, RPH

Provider Business Mailing Address
First Line	:	805 MISSISSIPPI ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66044-2660
Country	:	US
Telephone Number	:	816-223-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 RIDGE CT STE C
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3913
Country	:	US
Telephone Number	:	785-841-1950
Fax Number	:	785-841-1051

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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