Healthcare Provider Details

I. General information

NPI: 1942400031
Provider Name (Legal Business Name): BRYAN WILLIAM EDWARDS PHARM.D., BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE # 13-119
TUCSON AZ
85723-0001
US

IV. Provider business mailing address

3601 S 6TH AVE # 13-119
TUCSON AZ
85723-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax: 520-838-3617
Mailing address:
  • Phone: 520-792-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number5351
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5351
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: