MEDICARE: DR. LEE ANN BRADLEY RPH, PHARMD, BCPS

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	1835P1200X	Pharmacotherapy Pharmacist	2734	MT

General Provider Information

NPI Number	:	1851386502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE ANN BRADLEY RPH, PHARMD, BCPS

Provider Business Mailing Address
First Line	:	500 W BROADWAY ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4008
Country	:	US
Telephone Number	:	406-329-5617
Fax Number	:	406-329-5697

Provider Business Practice Location Address
First Line	:	500 W BROADWAY ST
Second Line	:	MONTANA SPINE CENTER
City	:	MISSOULA
State	:	MT
Zip	:	59802-4003
Country	:	US
Telephone Number	:	406-329-5617
Fax Number	:	406-329-5697

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	02/01/2016

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