Provider Demographics
NPI:1073925822
Name:BRYAN, AMANDA (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2907
Mailing Address - Country:US
Mailing Address - Phone:910-592-8444
Mailing Address - Fax:910-592-6505
Practice Address - Street 1:307 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2907
Practice Address - Country:US
Practice Address - Phone:910-592-8444
Practice Address - Fax:910-592-6505
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist