Individual
BRADLEY A ILLUMINATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 16TH ST S, BIRMINGHAM, AL 35205-6206
(410) 940-9087
Mailing address
1410 16TH ST S, BIRMINGHAM, AL 35205-6206
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
22932
AL
Other
Enumeration date
04/24/2023
Last updated
04/24/2023
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