Healthcare Provider Details

I. General information

NPI: 1407787864
Provider Name (Legal Business Name): BRYN ELIESSE CALHOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 RITTER DR
BEAVER WV
25813-9513
US

IV. Provider business mailing address

886 RITTER DR
BEAVER WV
25813-9513
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-0412
  • Fax: 304-256-0418
Mailing address:
  • Phone: 304-256-0412
  • Fax: 304-256-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0014902
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: