Provider Demographics
NPI:1760274849
Name:WUTHRICH, BRADLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:WUTHRICH
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 1:1362 BLACK BARK LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8242
Mailing Address - Country:US
Mailing Address - Phone:765-744-7846
Mailing Address - Fax:
Practice Address - Street 1:217 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2321
Practice Address - Country:US
Practice Address - Phone:231-935-6734
Practice Address - Fax:231-935-6979
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024125821835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology