Provider Demographics
NPI:1689997058
Name:BRYAN, HUGH DOUGLAS
Entity Type:Individual
Prefix:MR
First Name:HUGH
Middle Name:DOUGLAS
Last Name:BRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUTE 236
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-6514
Mailing Address - Country:US
Mailing Address - Phone:518-369-2072
Mailing Address - Fax:
Practice Address - Street 1:1 ROUTE 236
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-6514
Practice Address - Country:US
Practice Address - Phone:518-369-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist