Provider Demographics
NPI:1629306493
Name:DAVIDSON, BRYAN DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:DAVIDSON
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 1:100-F W DEAN KEETON ST
Mailing Address - Street 2:SUITE 1.110
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1043
Mailing Address - Country:US
Mailing Address - Phone:512-471-1824
Mailing Address - Fax:
Practice Address - Street 1:100-F W DEAN KEETON ST
Practice Address - Street 2:SUITE 1.110
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1043
Practice Address - Country:US
Practice Address - Phone:512-471-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45964183500000X
VA0202205726183500000X
NC16990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist