Provider Demographics
NPI:1003661125
Name:BRADLEY, MAREN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MAREN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MISSISSIPPI ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2660
Mailing Address - Country:US
Mailing Address - Phone:816-223-7784
Mailing Address - Fax:
Practice Address - Street 1:2336 RIDGE CT STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3913
Practice Address - Country:US
Practice Address - Phone:785-841-1950
Practice Address - Fax:785-841-1051
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist