MEDICARE: MRS. TAMMY BRADLEY 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	PS27546	FL

General Provider Information

NPI Number	:	1063794592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY BRADLEY RPH

Provider Business Mailing Address
First Line	:	12802 WINNERS CIR
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34610-4812
Country	:	US
Telephone Number	:	813-727-0943
Fax Number	:

Provider Business Practice Location Address
First Line	:	7827 LAND O LAKES BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-5706
Country	:	US
Telephone Number	:	813-528-4093
Fax Number	:	813-996-0075

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

Provider Enumeration Date	:	09/11/2011
Last Update Date	:	09/11/2011

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