Provider Demographics
NPI:1497278345
Name:STAFFORD, BRYCE ALAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:ALAN
Last Name:STAFFORD
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 1:103 REMINGTON PL
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5406
Mailing Address - Country:US
Mailing Address - Phone:843-323-0199
Mailing Address - Fax:
Practice Address - Street 1:1703 ELM STREET WEST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924
Practice Address - Country:US
Practice Address - Phone:803-943-0683
Practice Address - Fax:803-943-0783
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist