Provider Demographics
NPI:1013919059
Name:BRYANT, BARRY STEPHEN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:STEPHEN
Last Name:BRYANT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-5409
Mailing Address - Country:US
Mailing Address - Phone:803-442-3727
Mailing Address - Fax:706-798-0377
Practice Address - Street 1:2604 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2406
Practice Address - Country:US
Practice Address - Phone:706-798-5645
Practice Address - Fax:706-798-0377
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist