Healthcare Provider Details

I. General information

NPI: 1033253497
Provider Name (Legal Business Name): SANDI IRENE BRYANT PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 RETTA RD
FAIRVIEW NC
28730-8767
US

IV. Provider business mailing address

24 RAVENWOOD DR
FLETCHER NC
28732-9724
US

V. Phone/Fax

Practice location:
  • Phone: 828-628-3675
  • Fax: 828-628-3516
Mailing address:
  • Phone: 828-651-9101
  • Fax: 828-628-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number12099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: