Provider Demographics
NPI:1013299718
Name:BRYANT, JERRY BENSON (DPH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:BENSON
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3613
Mailing Address - Country:US
Mailing Address - Phone:931-424-5335
Mailing Address - Fax:931-424-6463
Practice Address - Street 1:620 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-3613
Practice Address - Country:US
Practice Address - Phone:931-424-5335
Practice Address - Fax:931-424-6463
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39161835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist