Provider Demographics
NPI:1063844991
Name:ANDERSON, BRYAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 NE MARYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-7120
Mailing Address - Country:US
Mailing Address - Phone:816-916-3110
Mailing Address - Fax:
Practice Address - Street 1:901 SW STATE ROUTE 150
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-4410
Practice Address - Country:US
Practice Address - Phone:816-623-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009021425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist