Provider Demographics
NPI:1548597073
Name:BRYCE, JAMES WITSCHEN II (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WITSCHEN
Last Name:BRYCE
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16459 JOOR RD
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-8630
Mailing Address - Country:US
Mailing Address - Phone:225-658-0608
Mailing Address - Fax:800-729-0167
Practice Address - Street 1:5323 MACHOST RD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-7232
Practice Address - Country:US
Practice Address - Phone:225-658-0608
Practice Address - Fax:800-729-0167
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16660183500000X
MST-010025183500000X
IL051290631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist