Organization
BRADLEY AND BRANDY NEIGHBORHOOD PHARMACY LLC
Active
Other names
BRADLEY AND BRANDY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE FORD PHARMD (CEO/PIC)
(770) 877-3005
Entity
Organization
Contact information
Practice address
11 LEGACY WAY, STE E, ADAIRSVILLE, GA 30103-2464
(770) 877-3005
(770) 877-3007
Mailing address
11 LEGACY WAY, STE E, ADAIRSVILLE, GA 30103-2464
(770) 877-3005
(770) 877-3007
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009464
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1157254
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
155898320A
—
GA
Enumeration date
05/06/2008
Last updated
08/20/2009
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