Provider Demographics
NPI:1538876081
Name:BRADLEY, COLBY (PHARMD)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 CRAMER CIR APT 312
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7856
Mailing Address - Country:US
Mailing Address - Phone:803-634-7571
Mailing Address - Fax:
Practice Address - Street 1:1900 SPRINGSTEEN RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6990
Practice Address - Country:US
Practice Address - Phone:803-985-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist