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NPI Code Detail

MEDICARE: MR. BRADLEY THIREN JOHNSON RPH,CGP,CDM

MEDICARE: MR. BRADLEY THIREN JOHNSON RPH,CGP,CDM
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
1183500000XPharmacist6258OR
21835P1200XPharmacotherapy PharmacistHD032131OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10759OTHERORGERIATRIC CERTIFICATION
26258OTHERORPHARMACY LISCENSE
3HD032131OTHERORDIABETES MANAGMENT CERTIF

General Provider Information

NPI Number : 1710984588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRADLEY THIREN JOHNSON RPH,CGP,CDM
Provider Business Mailing Address
First Line : 1125 LORELLA AVE
Second Line :
City : EUGENE
State : OR
Zip : 97401-7823
Country : US
Telephone Number : 541-343-7162
Fax Number : 541-242-8303
Provider Business Practice Location Address
First Line : 4010 AERIAL WAY
Second Line :
City : EUGENE
State : OR
Zip : 97402-9757
Country : US
Telephone Number : 541-242-8525
Fax Number : 541-242-8520
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 09/11/2025

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