Provider Demographics
NPI:1497750004
Name:BRYAN, ELLEN ADAMS (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ADAMS
Last Name:BRYAN
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 1:3430 WENDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-6925
Mailing Address - Country:US
Mailing Address - Phone:919-365-8800
Mailing Address - Fax:919-366-3659
Practice Address - Street 1:3430 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-6925
Practice Address - Country:US
Practice Address - Phone:919-365-8800
Practice Address - Fax:919-366-3659
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist