Provider Demographics
NPI:1548548969
Name:GRADY, WENDY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLD CLEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-6853
Mailing Address - Country:US
Mailing Address - Phone:775-881-2502
Mailing Address - Fax:775-881-2509
Practice Address - Street 1:700 OLD CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-6853
Practice Address - Country:US
Practice Address - Phone:775-881-2502
Practice Address - Fax:775-881-2509
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9933183500000X
CA41863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9933OtherPHARMACY LICENSE
CA41863OtherPHARMACY LICENSE