Provider Demographics
NPI:1770998742
Name:WOOD, BRADLEY (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N POPE ST STE P
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5161
Mailing Address - Country:US
Mailing Address - Phone:753-428-9005
Mailing Address - Fax:575-519-3008
Practice Address - Street 1:1007 N POPE ST STE P
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5161
Practice Address - Country:US
Practice Address - Phone:753-428-9005
Practice Address - Fax:575-519-3008
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist