MEDICARE: BRADLEY JOE MCGEE

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	15912	AL

General Provider Information

NPI Number	:	1144824046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY JOE MCGEE

Provider Business Mailing Address
First Line	:	1702 GLENN BLVD SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3523
Country	:	US
Telephone Number	:	256-845-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 GLENN BLVD SW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3523
Country	:	US
Telephone Number	:	256-845-0242
Fax Number	:

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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