Jessica Bradley
Individual provider Active NPI Pharmacist · Ferriday, LA
NPI 1821487182 · NPPES record last updated Jan 9, 2015
Key facts
- NPI
- 1821487182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PST.018571 (LA)
- Practice address
- 2094 Ee Wallace Blvd N
Ferriday, LA 71334-2233 - Phone
- (318) 757-8172
- Fax
- (318) 757-0762
- NPI assigned
- Jan 9, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PST.018571 | LA | MD | Pharmacist |
| E-010421 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PST.018571 | LA | Yes |
| Pharmacist | 183500000X | E-010421 | MS |
Addresses
Primary practice location
2094 Ee Wallace Blvd N
Ferriday, LA 71334-2233
Mailing address
2094 Ee Wallace Blvd N
Ferriday, LA 71334-2233
Phone (318) 757-8172
Other providers in Ferriday, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2015. 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.