Provider Demographics
NPI:1508281775
Name:KRISE, BRIAN M
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:KRISE
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 1:412 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1715
Mailing Address - Country:US
Mailing Address - Phone:910-799-9808
Mailing Address - Fax:910-799-9813
Practice Address - Street 1:412 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1715
Practice Address - Country:US
Practice Address - Phone:910-799-9808
Practice Address - Fax:910-799-9813
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist