MEDICARE: DR. KEYSHA BRYANT PHARMD

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	PS30564	FL

General Provider Information

NPI Number	:	1962095620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEYSHA BRYANT PHARMD

Provider Business Mailing Address
First Line	:	3826 VICTORIA RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6440
Country	:	US
Telephone Number	:	561-729-6031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3826 VICTORIA RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6440
Country	:	US
Telephone Number	:	561-729-6031
Fax Number	:

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

Provider Enumeration Date	:	02/14/2021
Last Update Date	:	02/14/2021

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