Provider Demographics
NPI:1275883019
Name:WILLIAMS, BRADY PHILIP (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRADY
Middle Name:PHILIP
Last Name:WILLIAMS
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 1:545 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-8000
Mailing Address - Country:US
Mailing Address - Phone:864-608-3446
Mailing Address - Fax:
Practice Address - Street 1:2401 E NORTH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1401
Practice Address - Country:US
Practice Address - Phone:864-244-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11617183500000X
FLPS0031951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11617OtherSOUTH CAROLINA STATE PHARMACY LICENSE
FLPS031951OtherFLORIDA STATE PHARMACY LICENSE