Provider Demographics
NPI:1528109659
Name:GIGLIOTTI, BRADLEY JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:JAMES
Last Name:GIGLIOTTI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W MAHONING ST
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1918
Mailing Address - Country:US
Mailing Address - Phone:814-938-8570
Mailing Address - Fax:814-938-4644
Practice Address - Street 1:219 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1918
Practice Address - Country:US
Practice Address - Phone:814-938-8570
Practice Address - Fax:814-938-4644
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038990L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005643280002Medicaid
PA0005643280002Medicaid