Provider Demographics
NPI:1003339748
Name:VAIO, BRYANNA M
Entity Type:Individual
Prefix:
First Name:BRYANNA
Middle Name:M
Last Name:VAIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 PARSIFAL ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2542
Mailing Address - Country:US
Mailing Address - Phone:505-269-7885
Mailing Address - Fax:
Practice Address - Street 1:460 NM HWY 528
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004
Practice Address - Country:US
Practice Address - Phone:505-771-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist