Individual
BRADLEY RENICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1201 HIGHWAY 71 S, MENA, AR 71953-8007
(479) 394-7136
Mailing address
1201 HIGHWAY 71 S, MENA, AR 71953-8007
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PD10589
AR
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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