MEDICARE: BRADLEY'S PHARMACY

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	333600000X	Pharmacy	7026	LA

General Provider Information

NPI Number	:	1063803195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY'S PHARMACY

Provider Business Mailing Address
First Line	:	8115 E SAINT BERNARD HWY
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5424
Country	:	US
Telephone Number	:	504-682-5236
Fax Number	:	504-682-6654

Provider Business Practice Location Address
First Line	:	8115 E SAINT BERNARD HWY
Second Line	:
City	:	SAINT BERNARD
State	:	LA
Zip	:	70085-5424
Country	:	US
Telephone Number	:	504-682-5236
Fax Number	:	504-682-6654

Authorized Official
Title or Position	:	MANAGER
Name	:	SHARON ANN JEANFREAU
Credential	:	PHARMACY TECH
Telephone Number	:	504-682-5236

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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Directions to “BRADLEY'S PHARMACY ” Practice Location

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