Provider Demographics
NPI:1568861698
Name:BRYAN, KENDRA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:
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 1:10516 HERSHEY DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1434
Mailing Address - Country:US
Mailing Address - Phone:301-667-0207
Mailing Address - Fax:
Practice Address - Street 1:10 E WILSON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7331
Practice Address - Country:US
Practice Address - Phone:301-790-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist