Provider Demographics
NPI:1619282779
Name:BARRY, BRENT THEODORE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:THEODORE
Last Name:BARRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 PASS RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2111
Mailing Address - Country:US
Mailing Address - Phone:626-390-1957
Mailing Address - Fax:
Practice Address - Street 1:2405 PASS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2111
Practice Address - Country:US
Practice Address - Phone:626-390-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS010771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist