Provider Demographics
NPI:1750634283
Name:BRYANT, KEITH W (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:W
Last Name:BRYANT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
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Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7301
Mailing Address - Country:US
Mailing Address - Phone:910-907-9791
Mailing Address - Fax:910-907-8443
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7301
Practice Address - Country:US
Practice Address - Phone:910-907-7435
Practice Address - Fax:910-907-8565
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2016-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC148671835P0018X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist