Provider Demographics
NPI:1376133041
Name:BERRYHILL, BRIAN LEE
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:BERRYHILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 BAY DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4402
Mailing Address - Country:US
Mailing Address - Phone:410-736-9101
Mailing Address - Fax:
Practice Address - Street 1:8665 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3020
Practice Address - Country:US
Practice Address - Phone:410-574-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist