Provider Demographics
NPI:1902128895
Name:BRADFORD, MELISSA LYN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYN
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25524 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4048
Mailing Address - Country:US
Mailing Address - Phone:440-892-0525
Mailing Address - Fax:440-892-1308
Practice Address - Street 1:25524 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4048
Practice Address - Country:US
Practice Address - Phone:440-892-0525
Practice Address - Fax:440-892-1308
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19902183500000X
OH03328756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist