Provider Demographics
NPI:1891591459
Name:BRYANT, JAMICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMICHAEL
Middle Name:
Last Name:BRYANT
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 OSAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2842
Mailing Address - Country:US
Mailing Address - Phone:318-584-3014
Mailing Address - Fax:
Practice Address - Street 1:3304 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7308
Practice Address - Country:US
Practice Address - Phone:318-651-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist