MEDICARE: MR. BRADLEY RAYMOND SANDRONI 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	0202009774	VA

General Provider Information

NPI Number	:	1457953960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY RAYMOND SANDRONI RPH

Provider Business Mailing Address
First Line	:	200 RIVENDELL CT
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22603-8629
Country	:	US
Telephone Number	:	540-550-4657
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 RIVENDELL CT
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22603-8629
Country	:	US
Telephone Number	:	540-545-8301
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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