Individual
JOHN MARK BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
7420 GUTHRIE DR N STE 110, SOUTHAVEN, MS 38671-5877
(662) 536-0384
(877) 536-4207
Mailing address
7420 GUTHRIE DR N STE 110, SOUTHAVEN, MS 38671-5877
(662) 536-0384
(877) 536-4207
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
T-010483
MS
Other
Enumeration date
03/23/2012
Last updated
03/23/2012
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