Provider Demographics
NPI:1063794899
Name:TARR, BRYAN DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:DOUGLAS
Last Name:TARR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:DOUGLAS
Other - Last Name:KOZIARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7846 ABALONE BAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6117
Mailing Address - Country:US
Mailing Address - Phone:702-255-5490
Mailing Address - Fax:
Practice Address - Street 1:8633 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5406
Practice Address - Country:US
Practice Address - Phone:702-383-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist