Provider Demographics
NPI:1255668646
Name:BRYANT, CARLA SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:SUE
Last Name:BRYANT
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 1:1102 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-5302
Mailing Address - Country:US
Mailing Address - Phone:281-471-7282
Mailing Address - Fax:281-471-1361
Practice Address - Street 1:1102 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-5302
Practice Address - Country:US
Practice Address - Phone:281-471-7282
Practice Address - Fax:281-471-1361
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist