Provider Demographics
NPI:1366780843
Name:BRYAN, SHARON R (RPH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:R
Last Name:BRYAN
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 1:5885 CUMMING HWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5765
Mailing Address - Country:US
Mailing Address - Phone:770-614-8866
Mailing Address - Fax:
Practice Address - Street 1:5885 CUMMING HWY
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5765
Practice Address - Country:US
Practice Address - Phone:770-614-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist