Provider Demographics
NPI:1013372333
Name:BRYSON, EDWARD LAWRENCE JR (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:BRYSON
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-4438
Mailing Address - Country:US
Mailing Address - Phone:828-877-6111
Mailing Address - Fax:828-877-6487
Practice Address - Street 1:518 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4438
Practice Address - Country:US
Practice Address - Phone:828-877-6111
Practice Address - Fax:828-877-6487
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist