David S Braddock, R.PH.
Individual provider Active NPI Pharmacist · Shreve, OH
NPI 1962485847 · NPPES record last updated Jul 15, 2008
Key facts
- NPI
- 1962485847
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 03-2-12838 (OH)
- Practice address
- 119 N. Market St.
Shreve, OH 44676 - Phone
- (330) 567-2823
- Fax
- (330) 567-2660
- NPI assigned
- Nov 23, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03-2-12838 | OH | Yes |
Addresses
Primary practice location
119 N. Market St.
Shreve, OH 44676
Mailing address
P.O. Box 582
119 N. Market St.
Shreve, OH 44676
Phone (330) 567-2823
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0665990 | Medicaid | OH |
Other providers in Shreve, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.