Provider Demographics
NPI:1982652251
Name:GARDNER, BRYAN J (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:GARDNER
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 1:465 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4645
Mailing Address - Country:US
Mailing Address - Phone:585-463-2705
Mailing Address - Fax:585-463-2695
Practice Address - Street 1:465 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4645
Practice Address - Country:US
Practice Address - Phone:585-463-2705
Practice Address - Fax:585-463-2695
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049180183500000X, 1835P0018X
OH03-3-25457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist