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Individual
MR. BRADLEY THIREN JOHNSON
Active
Individual
MR. BRADLEY THIREN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH,CGP,CDM
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6258
OR
1835P1200X
Pharmacotherapy Pharmacist
HD032131
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0759
GERIATRIC CERTIFICATION
OR
01
—
6258
PHARMACY LISCENSE
OR
01
—
HD032131
DIABETES MANAGMENT CERTIF
OR
Enumeration date
07/07/2005
Last updated
07/13/2026
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