Provider Demographics
NPI:1861774531
Name:COLEMAN, BRYAN R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 SPROWEL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GARBERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95542-3306
Mailing Address - Country:US
Mailing Address - Phone:707-921-7078
Mailing Address - Fax:707-921-7069
Practice Address - Street 1:286 SPROWEL CREEK RD
Practice Address - Street 2:
Practice Address - City:GARBERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95542-3306
Practice Address - Country:US
Practice Address - Phone:707-921-7078
Practice Address - Fax:707-921-7069
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66081OtherRPH LICENSE