Provider Demographics
NPI:1538769104
Name:BRYAN, TONYA BRUMBLEY (RPH)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:BRUMBLEY
Last Name:BRYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 BRUMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-7556
Mailing Address - Country:US
Mailing Address - Phone:850-519-7532
Mailing Address - Fax:
Practice Address - Street 1:1900 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5615
Practice Address - Country:US
Practice Address - Phone:850-223-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist