Provider Demographics
NPI:1548815475
Name:BRADLEY, MARY ANGELA (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANGELA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8909
Mailing Address - Country:US
Mailing Address - Phone:812-934-6624
Mailing Address - Fax:
Practice Address - Street 1:321 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8909
Practice Address - Country:US
Practice Address - Phone:812-934-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019037A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist