Provider Demographics
NPI:1346819315
Name:BRAID, ANDE DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:ANDE
Middle Name:DAVID
Last Name:BRAID
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 1:700 S BRADY ST
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1266
Mailing Address - Country:US
Mailing Address - Phone:181-437-1582
Mailing Address - Fax:814-371-5829
Practice Address - Street 1:700 S BRADY ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1266
Practice Address - Country:US
Practice Address - Phone:814-371-5827
Practice Address - Fax:814-371-5829
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034616L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist