Provider Demographics
NPI:1043293491
Name:BROWN, BRYANT LANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRYANT
Middle Name:LANE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1617
Mailing Address - Country:US
Mailing Address - Phone:843-752-0079
Mailing Address - Fax:843-752-0062
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1617
Practice Address - Country:US
Practice Address - Phone:842-752-0023
Practice Address - Fax:843-752-0062
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1619929684Medicare NSC