Provider Demographics
NPI:1790342293
Name:BRADY, KRISTEN OSCHWALD
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:OSCHWALD
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 2ND AVE E
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-2791
Mailing Address - Country:US
Mailing Address - Phone:205-625-3643
Mailing Address - Fax:205-625-3644
Practice Address - Street 1:2453 2ND AVE E
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2791
Practice Address - Country:US
Practice Address - Phone:205-625-3643
Practice Address - Fax:205-625-3644
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL16396OtherPHARMACY LICENSE