Provider Demographics
NPI:1063738268
Name:SMITH, BRADY TED (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:TED
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:UT
Mailing Address - Zip Code:84654-0129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 N 250 W
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-5514
Practice Address - Country:US
Practice Address - Phone:435-529-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5252155-1701183500000X
MT4601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist