Provider Demographics
NPI:1326431610
Name:NETELBEEK, BRAYDEN ALBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:ALBERT
Last Name:NETELBEEK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 E 9400 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2913
Mailing Address - Country:US
Mailing Address - Phone:801-308-1007
Mailing Address - Fax:
Practice Address - Street 1:2090 E 9400 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-2913
Practice Address - Country:US
Practice Address - Phone:801-308-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT77318441707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist