=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124385851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARCY MARIE BRYANT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 04/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2461 E GULF TO LAKE HWY
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34453-3232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-637-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2152 NW 165TH ST
-----------------------------------------------------
City | CITRA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32113-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-216-9288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 37790
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 25440
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------