Provider Demographics
NPI:1629353321
Name:MCNULTY, BRADY THOMAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:THOMAS
Last Name:MCNULTY
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 1:113 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-9556
Mailing Address - Country:US
Mailing Address - Phone:541-459-2712
Mailing Address - Fax:541-459-9129
Practice Address - Street 1:113 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUTHERLIN
Practice Address - State:OR
Practice Address - Zip Code:97479-9556
Practice Address - Country:US
Practice Address - Phone:541-459-2712
Practice Address - Fax:541-459-9129
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55018183500000X
OR14405183500000X, 1835P0018X
ORRPH-144051835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist