Provider Demographics
NPI:1962901439
Name:BRYANT, BLAIR ALYSSE (PHARMD)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:ALYSSE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 KIMBALL CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5649
Mailing Address - Country:US
Mailing Address - Phone:423-837-8671
Mailing Address - Fax:
Practice Address - Street 1:525 KIMBALL CROSSING DR
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5649
Practice Address - Country:US
Practice Address - Phone:423-837-8671
Practice Address - Fax:423-837-6559
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist