Provider Demographics
NPI:1780210997
Name:BELESKY, BRYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BELESKY
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 1:944 REFUGE WAY
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7437
Mailing Address - Country:US
Mailing Address - Phone:304-894-2408
Mailing Address - Fax:
Practice Address - Street 1:100 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9260
Practice Address - Country:US
Practice Address - Phone:843-234-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist