Healthcare Provider Details

I. General information

NPI: 1124937651
Provider Name (Legal Business Name): ANNA SHAIN BRYANT PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BRIARWOOD DR E
WARREN NJ
07059-6781
US

IV. Provider business mailing address

30 BRIARWOOD DR E
WARREN NJ
07059-6781
US

V. Phone/Fax

Practice location:
  • Phone: 973-452-9935
  • Fax:
Mailing address:
  • Phone: 973-452-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP045329L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: