Provider Demographics
NPI:1336181296
Name:BRADEN MED SVS INC
Entity Type:Organization
Organization Name:BRADEN MED SVS INC
Other - Org Name:GILLESPIES DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-732-2356
Mailing Address - Street 1:44523 MARIETTA RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9209
Mailing Address - Country:US
Mailing Address - Phone:740-732-2356
Mailing Address - Fax:740-732-2377
Practice Address - Street 1:44523 MARIETTA RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9209
Practice Address - Country:US
Practice Address - Phone:740-732-2356
Practice Address - Fax:740-732-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0212969503336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074368OtherPK
OH2286557Medicaid