Healthcare Provider Details

I. General information

NPI: 1679674154
Provider Name (Legal Business Name): WILLIAM EDWARD BRYAN III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST # 119
DURHAM NC
27705-3875
US

IV. Provider business mailing address

2625 SW 75TH ST APT 317
GAINESVILLE FL
32607-6636
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-0411
  • Fax:
Mailing address:
  • Phone: 919-225-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18215
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number18215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: