Healthcare Provider Details

I. General information

NPI: 1063738268
Provider Name (Legal Business Name): BRADY TED SMITH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N 250 W
SALINA UT
84654-5514
US

IV. Provider business mailing address

PO BOX 129
SALINA UT
84654-0129
US

V. Phone/Fax

Practice location:
  • Phone: 435-529-5988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5252155-1701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4601
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: