Provider Demographics
NPI:1821356007
Name:ANDERSON, BRYAN JOHN (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JOHN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7906 FOXFIELD DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6703
Mailing Address - Country:US
Mailing Address - Phone:319-389-6144
Mailing Address - Fax:
Practice Address - Street 1:1030 BLAIRS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-1220
Practice Address - Country:US
Practice Address - Phone:319-393-4348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist