Healthcare Provider Details

I. General information

NPI: 1932383551
Provider Name (Legal Business Name): DARRELL LAJUANE BRYANT PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E BROAD ST
COLUMBUS OH
43205-1550
US

IV. Provider business mailing address

PO BOX 1297
HILLIARD OH
43026-6297
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0711
  • Fax: 614-252-9250
Mailing address:
  • Phone: 614-850-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03325389
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number03325389
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: