Provider Demographics
NPI:1750412508
Name:BRADYS PHARMACY INC
Entity type:Organization
Organization Name:BRADYS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHARMACIST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-628-6362
Mailing Address - Street 1:214 S MAIN ST
Mailing Address - Street 2:P O BOX 68
Mailing Address - City:FAIRMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28340-1904
Mailing Address - Country:US
Mailing Address - Phone:910-628-6362
Mailing Address - Fax:910-628-9334
Practice Address - Street 1:214 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:NC
Practice Address - Zip Code:28340-1904
Practice Address - Country:US
Practice Address - Phone:910-628-6362
Practice Address - Fax:910-628-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3606332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0579930001Medicare NSC