MEDICARE: BRADFORD ROGERS STURGIS 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	9717	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053636076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD ROGERS STURGIS RPH

Provider Business Mailing Address
First Line	:	PO BOX 220
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-0220
Country	:	US
Telephone Number	:	334-683-6166
Fax Number	:	334-683-9621

Provider Business Practice Location Address
First Line	:	304 WASHINGTON ST
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-2332
Country	:	US
Telephone Number	:	334-683-6166
Fax Number	:	334-683-9621

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

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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