Provider Demographics
NPI:1730474206
Name:NELSON, BRIAN WARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WARD
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 DYNASTY DR
Mailing Address - Street 2:TARGET 2369
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5574
Mailing Address - Country:US
Mailing Address - Phone:239-265-9023
Mailing Address - Fax:239-265-9033
Practice Address - Street 1:9350 DYNASTY DR
Practice Address - Street 2:TARGET 2369
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5574
Practice Address - Country:US
Practice Address - Phone:239-265-9023
Practice Address - Fax:239-265-9033
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00151831835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist