Provider Demographics
NPI:1558965772
Name:BRYANT, JORDAN O'RYAN (RPH)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:O'RYAN
Last Name:BRYANT
Suffix:
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 1:110 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2510
Mailing Address - Country:US
Mailing Address - Phone:832-673-7131
Mailing Address - Fax:832-673-7137
Practice Address - Street 1:110 W 20TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2510
Practice Address - Country:US
Practice Address - Phone:832-673-7131
Practice Address - Fax:832-673-7137
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist