Individual
BRADLEY TYLER PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMACY INTERN
Contact information
Practice address
620 LONG POINT RD, MOUNT PLEASANT, SC 29464-8363
(843) 856-4902
Mailing address
530 MEETING ST, CHARLESTON, SC 29403-5069
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
I-49482
SC
Other
Enumeration date
10/14/2024
Last updated
10/14/2024
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