Healthcare Provider Details

I. General information

NPI: 1720074776
Provider Name (Legal Business Name): BRYAN D. MONROE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTHCENTER CT STE 100
MORRISVILLE NC
27560-9125
US

IV. Provider business mailing address

12209 KAYSMOUNT CT
RALEIGH NC
27614-6936
US

V. Phone/Fax

Practice location:
  • Phone: 919-268-1476
  • Fax:
Mailing address:
  • Phone: 919-570-0610
  • Fax: 919-603-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13972
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: