Provider Demographics
NPI:1114181856
Name:BRYSON, SANDRA RAE (RPH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:RAE
Last Name:BRYSON
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 1:1336 ADELE RD
Mailing Address - Street 2:
Mailing Address - City:MONTOURSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17754-9555
Mailing Address - Country:US
Mailing Address - Phone:570-368-2106
Mailing Address - Fax:
Practice Address - Street 1:1015 N LOYALSOCK AVE
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-1065
Practice Address - Country:US
Practice Address - Phone:570-368-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038129L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist