Provider Demographics
NPI:1447250154
Name:BRADBURN, HARRY (DPH)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:BRADBURN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4273
Mailing Address - Country:US
Mailing Address - Phone:423-639-6789
Mailing Address - Fax:
Practice Address - Street 1:1510 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4273
Practice Address - Country:US
Practice Address - Phone:423-639-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4272183500000X
TX40374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist