MEDICARE: MR. HARRY BRADBURN D.PH.

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	4272	TN
2	183500000X	Pharmacist	40374	TX

General Provider Information

NPI Number	:	1447250154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARRY BRADBURN D.PH.

Provider Business Mailing Address
First Line	:	1510 E ANDREW JOHNSON HWY
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4273
Country	:	US
Telephone Number	:	423-639-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1510 E ANDREW JOHNSON HWY
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4273
Country	:	US
Telephone Number	:	423-639-6789
Fax Number	:

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/24/2007

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