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General NPI Number Information
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NPI Number | 1639055890
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Entity Type | Individual
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Provider Name | BRAYDEN SHIRLEY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 172 E MCARTHUR DR
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City | BETHALTO
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State | IL
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Zip | 62010-1776
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Country | US
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Telephone | 618-258-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 46 WOODCREST DR
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City | BETHALTO
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State | IL
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Zip | 62010-2195
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051307240
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License Number State | IL
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