Healthcare Provider Details

I. General information

NPI: 1356361323
Provider Name (Legal Business Name): LISA LEE BRYAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOCUST ST # 119
RENO NV
89502-2597
US

IV. Provider business mailing address

1000 LOCUST ST # 119
RENO NV
89502-2597
US

V. Phone/Fax

Practice location:
  • Phone: 775-328-1840
  • Fax: 775-328-1838
Mailing address:
  • Phone: 775-328-1840
  • Fax: 775-328-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number15979
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH00039708
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: