Provider Demographics
NPI:1679052146
Name:CHUDNOW, BRYAN ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:ALEXANDER
Last Name:CHUDNOW
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 1:3764 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5754
Mailing Address - Country:US
Mailing Address - Phone:414-380-0265
Mailing Address - Fax:
Practice Address - Street 1:820 N SAMUEL MOORE PKWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1467
Practice Address - Country:US
Practice Address - Phone:317-483-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027954A1835P2201X
NC25226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist