Provider Demographics
NPI:1205035441
Name:BRYNER, JODI KATHERINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:KATHERINE
Last Name:BRYNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8577
Mailing Address - Country:US
Mailing Address - Phone:925-813-3116
Mailing Address - Fax:
Practice Address - Street 1:5601 DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-8577
Practice Address - Country:US
Practice Address - Phone:925-813-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist