=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750009072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUBREY BRYANSMITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2022
-----------------------------------------------------
Last Update Date | 08/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 920 RED LION RD
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19115-1500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-676-5701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 549 PONDVIEW RD
-----------------------------------------------------
City | RYDAL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | RP456934
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------