Provider Demographics
NPI:1104106855
Name:DELLARIA, BRYAN A (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:A
Last Name:DELLARIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 PLEASANT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-1971
Mailing Address - Country:US
Mailing Address - Phone:978-457-5067
Mailing Address - Fax:
Practice Address - Street 1:59 WATERFRONT PLZ
Practice Address - Street 2:STE 2
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4877
Practice Address - Country:US
Practice Address - Phone:802-334-6785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0072359183500000X
NH3729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist