Provider Demographics
NPI:1841595295
Name:BRADY, JOHN FAUNCE III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FAUNCE
Last Name:BRADY
Suffix:III
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 1:807 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7230
Mailing Address - Country:US
Mailing Address - Phone:848-448-5275
Mailing Address - Fax:
Practice Address - Street 1:9628 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6697
Practice Address - Country:US
Practice Address - Phone:704-542-5072
Practice Address - Fax:704-542-7035
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist