Provider Demographics
NPI:1780900514
Name:MCFADDEN, BRENT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:MCFADDEN
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 1:1091 N BLUFF ST
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4894
Mailing Address - Country:US
Mailing Address - Phone:435-673-9781
Mailing Address - Fax:
Practice Address - Street 1:1091 N BLUFF ST
Practice Address - Street 2:SUITE 1005
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4894
Practice Address - Country:US
Practice Address - Phone:435-674-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT295094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist