Provider Demographics
NPI:1679742043
Name:GILL, BRADLEY W (PHARM D)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:GILL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1567
Mailing Address - Country:US
Mailing Address - Phone:750-768-4446
Mailing Address - Fax:570-768-4448
Practice Address - Street 1:50 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1567
Practice Address - Country:US
Practice Address - Phone:750-768-4446
Practice Address - Fax:570-768-4448
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046040L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist