Bradley E Homman, RPH
Individual provider Active NPI Pharmacist · Fort Detrick, MD
NPI 1770795437 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1770795437
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 11234 (CO)
- Practice address
- 1434 Porter St
Fort Detrick, MD 21702-9210 - Phone
- (301) 619-6710
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 11234 | CO | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11234 | CO | Yes |
Addresses
Primary practice location
1434 Porter St
Fort Detrick, MD 21702-9210
Mailing address
1434 Porter Street
Fort Detrick, MD 21702-9210
Phone (301) 619-6710
Other providers in Fort Detrick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.