Provider Demographics
NPI:1306067780
Name:CANADY, SCOTTY BRADFORD (PHARMD, RPH)
Entity type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:BRADFORD
Last Name:CANADY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 FAULKNER LN
Mailing Address - Street 2:#203
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3665
Mailing Address - Country:US
Mailing Address - Phone:727-372-9606
Mailing Address - Fax:
Practice Address - Street 1:1640 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5605
Practice Address - Country:US
Practice Address - Phone:727-938-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39576183500000X
NC16960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16960OtherREGISTERED PHARMACIST
FLPS39576OtherREGISTERED PHARMACIST