Provider Demographics
NPI:1386092518
Name:FOX, BRYANT (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYANT
Middle Name:
Last Name:FOX
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 1:6101 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1931
Mailing Address - Country:US
Mailing Address - Phone:215-924-9645
Mailing Address - Fax:215-924-0547
Practice Address - Street 1:6101 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1931
Practice Address - Country:US
Practice Address - Phone:215-924-9645
Practice Address - Fax:215-924-0547
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist