Provider Demographics
NPI:1730686932
Name:LOEFFEL, BRADLEY THOMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:THOMAS
Last Name:LOEFFEL
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 1:4150 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-0300
Mailing Address - Country:US
Mailing Address - Phone:662-253-6181
Mailing Address - Fax:
Practice Address - Street 1:4150 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-0300
Practice Address - Country:US
Practice Address - Phone:662-253-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-14539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist