MEDICARE: SHARON R BRYAN RPH

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	018641	GA

General Provider Information

NPI Number	:	1366780843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON R BRYAN RPH

Provider Business Mailing Address
First Line	:	5885 CUMMING HWY
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-5765
Country	:	US
Telephone Number	:	770-614-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 CUMMING HWY
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-5765
Country	:	US
Telephone Number	:	770-614-8866
Fax Number	:

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

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/18/2013

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