Provider Demographics
NPI:1194028035
Name:ROSENBLUTH, BRADY WARREN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADY
Middle Name:WARREN
Last Name:ROSENBLUTH
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 1:701 FRANCIS KING ST.
Mailing Address - Street 2:HARRIS TEETER PHARMACY #033
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410
Mailing Address - Country:US
Mailing Address - Phone:336-856-8182
Mailing Address - Fax:336-856-8145
Practice Address - Street 1:701 FRANCIS KING ST.
Practice Address - Street 2:HARRIS TEETER PHARMACY #033
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-856-8182
Practice Address - Fax:336-856-8145
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist