Provider Demographics
NPI:1730518705
Name:BRYAN, SHALOAM (PHARM D)
Entity type:Individual
Prefix:DR
First Name:SHALOAM
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 PRICES GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-5806
Mailing Address - Country:US
Mailing Address - Phone:423-272-9393
Mailing Address - Fax:
Practice Address - Street 1:4331 HIGHWAY 66 S
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3145
Practice Address - Country:US
Practice Address - Phone:423-272-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000033018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist