Provider Demographics
NPI:1447627005
Name:PERDUE, BRADY (PHARMD)
Entity type:Individual
Prefix:
First Name:BRADY
Middle Name:
Last Name:PERDUE
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 1:3058 GARDENIA LN SW
Mailing Address - Street 2:10-102
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6062
Mailing Address - Country:US
Mailing Address - Phone:970-302-6400
Mailing Address - Fax:
Practice Address - Street 1:3215 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8704
Practice Address - Country:US
Practice Address - Phone:360-956-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60577006183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist