=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972087310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR BRADY PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2018
-----------------------------------------------------
Last Update Date | 04/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32351 N SCOTTSDALE RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85266-1513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-575-5910
-----------------------------------------------------
Fax | 480-282-9796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5430 W LYDIA LN
-----------------------------------------------------
City | LAVEEN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85339-3054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-272-0960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S023986
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------