Provider Demographics
NPI:1174860738
Name:BRADY, JOHN SAMUEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SAMUEL
Last Name:BRADY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16025 N 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-3814
Mailing Address - Country:US
Mailing Address - Phone:602-866-0098
Mailing Address - Fax:
Practice Address - Street 1:16025 N 33RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-3814
Practice Address - Country:US
Practice Address - Phone:602-866-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist