Provider Demographics
NPI:1235211772
Name:DADY, J. MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:J.
Middle Name:MARK
Last Name:DADY
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 1:323 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-2534
Mailing Address - Country:US
Mailing Address - Phone:605-844-5334
Mailing Address - Fax:605-845-3575
Practice Address - Street 1:323 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-2534
Practice Address - Country:US
Practice Address - Phone:605-844-5334
Practice Address - Fax:605-845-3575
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist