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NPI 1225442155

IndividualActive

Bradley Provence

NPI 1225442155 · Nutrition Support Pharmacist · Millington, TN

Provider details

NPI number: 1225442155
Entity type: Individual
Primary specialty: Nutrition Support PharmacistPharmacy Service Providers
Sex: Male
Sole proprietor: Yes
License: 7696 (TN)

Practice location

7899 C St

Millington, TN 38053-2137

Phone: (901) 872-2214

More TN providers

Mailing address

7899 C St

Millington, TN 38053-2137

Registry dates

Enumerated: 2014-06-18
Last updated: 2014-06-18

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Bradley Provence — NPI 1225442155, Millington, TN | NPI Central