Basic Information
| Provider Information | |||||||||
| NPI: | 1841595295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FAUNCE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 807 SPRINGWOOD DR | ||||||||
| Address2: | |||||||||
| City: | WAXHAW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281737230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8484485275 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9628 REA RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282776697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045425072 | ||||||||
| FaxNumber: | 7045427035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2011 | ||||||||
| LastUpdateDate: | 01/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18120 | NC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.