Individual provider Active NPI

Brad Daugherty, RPH

  • Pharmacist
  • Kerrville, TX
National Provider Identifier
1205177011
Registry record updated Mar 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
48245 Issued in TX
Practice address
313 Sidney Baker St S
Kerrville, TX 78028-5916
Phone
(830) 792-5465
Fax
(830) 792-5464
NPI assigned
Mar 5, 2013
Last updated
Mar 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 48245 TX Primary
Pharmacist 183500000X 03213757 OH

Addresses

Primary practice location

313 Sidney Baker St S
Kerrville, TX 78028-5916

Mailing address

313 Sidney Baker St S
Kerrville, TX 78028-5916
Phone (830) 792-5465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
03213757OHMDPharmacist
48245TXMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362441600000",
    "number": "1205177011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 SIDNEY BAKER ST S",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285916",
            "telephone_number": "830-792-5465",
            "fax_number": "830-792-5464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 SIDNEY BAKER ST S",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285916",
            "telephone_number": "830-792-5465",
            "fax_number": "830-792-5464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "BRAD",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-05",
        "last_updated": "2013-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "48245",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "OH",
            "license": "03213757",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kerrville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.