Individual
LARRY L. BRADEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
4797 S MAIN ST, ACWORTH, GA 30101-5339
(770) 974-5234
(770) 974-3028
Mailing address
4797 S MAIN ST, ACWORTH, GA 30101-5339
(770) 974-5234
(770) 974-3028
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
008980
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030357B
—
GA
05
—
30019170A
—
GA
Enumeration date
09/24/2006
Last updated
10/08/2019
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