Provider Demographics
NPI:1164560546
Name:DOWDING, BRADY J (PHARMD RPH)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:J
Last Name:DOWDING
Suffix:
Gender:M
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 EAST ALICE STREET
Mailing Address - Street 2:PO BOX 400, STATE HOSPITAL SOUTH PHARMACY
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221
Mailing Address - Country:US
Mailing Address - Phone:208-785-8446
Mailing Address - Fax:
Practice Address - Street 1:700 EAST ALICE STREET
Practice Address - Street 2:STATE HOSPITAL SOUTH PHARMACY
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221
Practice Address - Country:US
Practice Address - Phone:208-785-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist