Healthcare Provider Details

I. General information

NPI: 1780900514
Provider Name (Legal Business Name): BRENT MCFADDEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091 N BLUFF ST SUITE 1005
ST GEORGE UT
84770-4894
US

IV. Provider business mailing address

1091 N BLUFF ST SUITE 1005
ST GEORGE UT
84770-4894
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-5667
  • Fax:
Mailing address:
  • Phone: 435-673-9781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number295094
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: