Provider Demographics
NPI:1174896195
Name:BRADLEY, ALYNDA LOUGHRIDGE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALYNDA
Middle Name:LOUGHRIDGE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 MARTIN SPRINGS DR STE 220B
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2980
Mailing Address - Country:US
Mailing Address - Phone:573-458-6432
Mailing Address - Fax:573-458-6430
Practice Address - Street 1:1605 MARTIN SPRINGS DR STE 220B
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2980
Practice Address - Country:US
Practice Address - Phone:573-458-6432
Practice Address - Fax:573-458-6430
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist