MEDICARE: BRAYDEN PATRICK GEORGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	75805	TX

General Provider Information

NPI Number	:	1124919725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAYDEN PATRICK GEORGE

Provider Business Mailing Address
First Line	:	302 CREEKSIDE CV
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-7684
Country	:	US
Telephone Number	:	512-705-7926
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 S CAPITAL OF TEXAS HWY BLDG C
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5256
Country	:	US
Telephone Number	:	512-705-7926
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2025
Last Update Date	:	07/11/2025

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