Provider Demographics
NPI:1639542392
Name:BRADY, WILLIAM SCOTT
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCOTT
Last Name:BRADY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:SCOTT
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:8861 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-4058
Mailing Address - Country:US
Mailing Address - Phone:916-989-4001
Mailing Address - Fax:916-989-6715
Practice Address - Street 1:8861 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-4058
Practice Address - Country:US
Practice Address - Phone:916-989-4001
Practice Address - Fax:916-989-6715
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWSB08371OtherPHARMACY