Provider Demographics
NPI:1295942977
Name:BRYANT, MARIA DIANN (RPH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DIANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 TURTLE RIVER CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-3739
Mailing Address - Country:US
Mailing Address - Phone:817-581-6077
Mailing Address - Fax:
Practice Address - Street 1:2310 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7335
Practice Address - Country:US
Practice Address - Phone:972-929-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist