Provider Demographics
NPI:1376826156
Name:FOUSEL, BRYAN CAMERON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CAMERON
Last Name:FOUSEL
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 1:4001 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1716
Mailing Address - Country:US
Mailing Address - Phone:303-451-5562
Mailing Address - Fax:303-451-1682
Practice Address - Street 1:4001 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-1716
Practice Address - Country:US
Practice Address - Phone:303-451-5562
Practice Address - Fax:303-451-1682
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist