Provider Demographics
NPI:1851610828
Name:DEAN, BRYAN L (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:L
Last Name:DEAN
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 1:224 TI PI LN
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-3806
Mailing Address - Country:US
Mailing Address - Phone:706-483-0713
Mailing Address - Fax:
Practice Address - Street 1:1308 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3827
Practice Address - Country:US
Practice Address - Phone:706-278-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist