Provider Demographics
NPI:1649547845
Name:BRADFORD, LAUREN HARRIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:HARRIS
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:CHRISTINE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1340 BON TERRE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064
Mailing Address - Country:US
Mailing Address - Phone:334-728-2102
Mailing Address - Fax:
Practice Address - Street 1:6680 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4240
Practice Address - Country:US
Practice Address - Phone:334-409-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist