Provider Demographics
NPI:1689956682
Name:BECKNER, BRADY (RPH)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:BECKNER
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 1:6961 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5201
Mailing Address - Country:US
Mailing Address - Phone:317-782-8905
Mailing Address - Fax:317-791-8332
Practice Address - Street 1:6961 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5201
Practice Address - Country:US
Practice Address - Phone:317-782-8905
Practice Address - Fax:317-791-8332
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018209A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist