Provider Demographics
NPI:1275841744
Name:BRYSON, WILLIAM PATRICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:BRYSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-9438
Mailing Address - Country:US
Mailing Address - Phone:662-983-2712
Mailing Address - Fax:662-983-2716
Practice Address - Street 1:403 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MS
Practice Address - Zip Code:38915-9438
Practice Address - Country:US
Practice Address - Phone:662-983-2712
Practice Address - Fax:662-983-2716
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-18
Last Update Date:2010-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE5298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist