Provider Demographics
NPI:1275616799
Name:BRADY, ISAAC FRED III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:FRED
Last Name:BRADY
Suffix:III
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27313-0038
Mailing Address - Country:US
Mailing Address - Phone:336-392-5857
Mailing Address - Fax:
Practice Address - Street 1:4822 PLESANT GARDEN RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GARDEN
Practice Address - State:NC
Practice Address - Zip Code:27313-8253
Practice Address - Country:US
Practice Address - Phone:336-674-5121
Practice Address - Fax:336-674-0995
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist