Provider Demographics
NPI:1134674765
Name:BRYANT, CHELSEA VICTORIA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:VICTORIA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E KELLOGG RD
Mailing Address - Street 2:APT A8
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8133
Mailing Address - Country:US
Mailing Address - Phone:269-290-3222
Mailing Address - Fax:
Practice Address - Street 1:1070 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3509
Practice Address - Country:US
Practice Address - Phone:360-647-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60644963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist