Provider Demographics
NPI:1629690979
Name:ALEXANDER, BRYAN THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
Last Name:ALEXANDER
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 1:16268 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2508
Mailing Address - Country:US
Mailing Address - Phone:402-403-4315
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PHARMACEUTICAL & NUTRITION CARE
Practice Address - Street 2:981090 NEBRASKA MEDICAL CENTER
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1090
Practice Address - Country:US
Practice Address - Phone:402-836-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070266061835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist