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1255812723 NPI number — BRYCESON G MALONE II PHARMD

NPI Number: 1255812723
Health Care Provider/Practitioner: BRYCESON G MALONE II PHARMD

Information about “1255812723” NPI (BRYCESON G MALONE II PHARMD) exists in 1255812723 in HTML format HTML  |  1255812723 in plain Text format TXT  |  1255812723 in PDF (Portable Document Format) PDF  |  1255812723 in an XML format XML  formats.

NPI Number : 1255812723 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255812723",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MALONE",
    "FirstName": "BRYCESON",
    "MiddleName": "G",
    "NamePrefix": "DR.",
    "NameSuffix": "II",
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "395 BAYMOUNT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATESVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28625-9548",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-537-4881",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "191 CARL ELLER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARS HILL",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28754-6262",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "828-689-5757",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/23/2018",
    "LastUpdateDate": "08/23/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "27635",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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