Provider Demographics
NPI:1720074776
Name:MONROE, BRYAN D (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:MONROE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12209 KAYSMOUNT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6936
Mailing Address - Country:US
Mailing Address - Phone:919-570-0610
Mailing Address - Fax:919-603-5384
Practice Address - Street 1:100 SOUTHCENTER CT STE 100
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9125
Practice Address - Country:US
Practice Address - Phone:919-268-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist