Provider Demographics
NPI:1679158752
Name:BRYANT, MATTHEW DALE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DALE
Last Name:BRYANT
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 1:471 PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2237
Mailing Address - Country:US
Mailing Address - Phone:415-846-1239
Mailing Address - Fax:
Practice Address - Street 1:471 PEPPER AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2237
Practice Address - Country:US
Practice Address - Phone:415-846-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist