Provider Demographics
NPI:1407457575
Name:BRYANT, JONIE DENA (RPH)
Entity Type:Individual
Prefix:
First Name:JONIE
Middle Name:DENA
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 1:900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MO
Mailing Address - Zip Code:65560-1639
Mailing Address - Country:US
Mailing Address - Phone:157-372-9330
Mailing Address - Fax:
Practice Address - Street 1:900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1639
Practice Address - Country:US
Practice Address - Phone:157-372-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004032872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist