Lori Rae Bradley, RPH
Individual provider Active NPI Pharmacist · Kelsey, CA
NPI 1194133660 · NPPES record last updated Jul 29, 2014
Key facts
- NPI
- 1194133660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 49569 (CA)
- Practice address
- 6021 W Red Berry Hill LN
Kelsey, CA 95667-7402 - Phone
- (530) 622-0206
- NPI assigned
- Jul 29, 2014
- Sex
- Female
- 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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49569 | CA | MD | Dentist |
| 26019332A | IN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 49569 | CA | Yes |
| Pharmacist | 183500000X | 26019332A | IN |
Addresses
Primary practice location
6021 W Red Berry Hill LN
Kelsey, CA 95667-7402
Mailing address
6021 W Red Berry Hill LN
Kelsey, CA 95667-7402
Phone (530) 622-0206
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 152282 | Other | CA | NABP |
Other providers in Kelsey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 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.