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NPI Code Detail

MEDICARE: RUTH BRYAN

MEDICARE: RUTH BRYAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist21516FL

General Provider Information

NPI Number : 1114200169
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH BRYAN
Provider Business Mailing Address
First Line : 2501 VIRGINIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5588
Country : US
Telephone Number : 772-595-3077
Fax Number :
Provider Business Practice Location Address
First Line : 2501 VIRGINIA AVE
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-5588
Country : US
Telephone Number : 772-595-3077
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2011
Last Update Date : 09/27/2011

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Directions to “ RUTH BRYAN ” Practice Location

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