Provider Demographics
NPI:1285610808
Name:BRYAN, AMBER ELISE
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:ELISE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23240 88TH AVE S APT WW-202
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031
Mailing Address - Country:US
Mailing Address - Phone:206-856-7046
Mailing Address - Fax:206-726-3498
Practice Address - Street 1:230240 88TH AVE S APT WW-202
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031
Practice Address - Country:US
Practice Address - Phone:206-856-7046
Practice Address - Fax:206-726-3498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician