Provider Demographics
NPI:1326526062
Name:PETROW, BRYAN ELLIOT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ELLIOT
Last Name:PETROW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-9674
Mailing Address - Country:US
Mailing Address - Phone:802-735-4150
Mailing Address - Fax:651-602-3643
Practice Address - Street 1:823 FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9092
Practice Address - Country:US
Practice Address - Phone:802-735-4150
Practice Address - Fax:651-602-3643
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0124478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty