MEDICARE: RICHARD CHARLES BRADLEY R.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	11135	SC

General Provider Information

NPI Number	:	1619992062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHARLES BRADLEY R.PH.

Provider Business Mailing Address
First Line	:	6 DEEP SPRINGS WAY
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-4966
Country	:	US
Telephone Number	:	864-675-9131
Fax Number	:	864-253-8690

Provider Business Practice Location Address
First Line	:	201 W SAINT JOHN ST
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-2336
Country	:	US
Telephone Number	:	864-253-8600
Fax Number	:	864-253-8690

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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