Provider Demographics
NPI:1184229502
Name:BRYAN, KATELYN LAUGHLIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:LAUGHLIN
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MCKINLEY
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6470B CEDAR BEND CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5300
Mailing Address - Country:US
Mailing Address - Phone:251-423-1678
Mailing Address - Fax:
Practice Address - Street 1:4154 WULFF RD E STE E
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5287
Practice Address - Country:US
Practice Address - Phone:251-645-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist