Paul Tucker Bradley, PHARM. D.
Individual provider Active NPI Pharmacist · North Logan, UT
NPI 1164822995 · NPPES record last updated Aug 28, 2014
Key facts
- NPI
- 1164822995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 8368522-1701 (UT)
- Practice address
- 1550 N Main St
North Logan, UT 84341-1918 - Phone
- (435) 753-0330
- Fax
- (435) 753-1969
- NPI assigned
- Aug 28, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8368522-1701 | UT | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8368522-1701 | UT | Yes |
Addresses
Primary practice location
1550 N Main St
North Logan, UT 84341-1918
Mailing address
636 S 180 E
Smithfield, UT 84335-1669
Phone (540) 394-0318
Other providers in North Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.