Provider Demographics
NPI:1093062846
Name:FOOTE, BRYCE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:FOOTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ARSENAL ST
Mailing Address - Street 2:T-1442
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2853
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 ARSENAL ST
Practice Address - Street 2:T-1442
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2853
Practice Address - Country:US
Practice Address - Phone:617-924-5987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist