Provider Demographics
NPI:1285462705
Name:ELLIOTT, BRYCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:ELLIOTT
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 1:900 CHAPEL ST APT RC110
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2818
Mailing Address - Country:US
Mailing Address - Phone:859-353-2525
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PHARMACY
Practice Address - Street 2:20 YORK ST, PS-LL
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:859-353-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0016726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist