MEDICARE: JESSICA BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202219037	VA

General Provider Information

NPI Number	:	1598371353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BRYANT

Provider Business Mailing Address
First Line	:	630 DENHAM ARCH
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23322-6848
Country	:	US
Telephone Number	:	757-641-2559
Fax Number	:

Provider Business Practice Location Address
First Line	:	5795 PRINCESS ANNE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3224
Country	:	US
Telephone Number	:	757-490-0307
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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