MEDICARE: CHRISTINE JD BRYANT PHARMD, BCGP

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
1	183500000X	Pharmacist	0202207129	VA

General Provider Information

NPI Number	:	1215939749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE JD BRYANT PHARMD, BCGP

Provider Business Mailing Address
First Line	:	11424 HUNTON COTTAGE CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059
Country	:	US
Telephone Number	:	804-222-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 WILLOW LAWN DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3427
Country	:	US
Telephone Number	:	804-288-3859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/14/2019

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