Provider Demographics
NPI:1093053456
Name:WALKER, BRYAN CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:CHARLES
Last Name:WALKER
Suffix:
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 1:1020 1ST ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-3806
Mailing Address - Country:US
Mailing Address - Phone:541-269-4033
Mailing Address - Fax:541-269-4034
Practice Address - Street 1:1020 1ST ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3806
Practice Address - Country:US
Practice Address - Phone:541-269-4033
Practice Address - Fax:541-269-4034
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR9145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist