Provider Demographics
NPI:1639773385
Name:SANDY, BRYAN CHARLES (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:CHARLES
Last Name:SANDY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-3753
Mailing Address - Country:US
Mailing Address - Phone:508-765-0646
Mailing Address - Fax:508-764-7210
Practice Address - Street 1:399 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-3753
Practice Address - Country:US
Practice Address - Phone:508-765-0646
Practice Address - Fax:508-764-7210
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist