MEDICARE: KELLY BRADSHAW PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	26026356A	IN

General Provider Information

NPI Number	:	1952906448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY BRADSHAW PHARMD

Provider Business Mailing Address
First Line	:	2211 E CENTER ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3719
Country	:	US
Telephone Number	:	574-269-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 E CENTER ST
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3719
Country	:	US
Telephone Number	:	574-269-6674
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	05/22/2026

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