MEDICARE: DR. BRADLEY PAUL STOLTZ PHARMD., 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	1835N0905X	Nuclear Pharmacist	16105	CO

General Provider Information

NPI Number	:	1770659229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADLEY PAUL STOLTZ PHARMD., RPH.

Provider Business Mailing Address
First Line	:	6 BELFAIR CT
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-8263
Country	:	US
Telephone Number	:	803-542-7343
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CORPORATE BLVD
Second Line	:	STE 108
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4665
Country	:	US
Telephone Number	:	803-794-5950
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	03/08/2011

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