Individual
MR. CHARLES MARVIN BRYANT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2730 S PRAIRIE AVE, PUEBLO, CO 81005-3167
(719) 696-6159
(719) 696-6170
Mailing address
1609 ZUNI RD, PUEBLO, CO 81001-1620
(719) 568-5009
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PHATP.0006919
CO
Other
Enumeration date
01/30/2021
Last updated
01/30/2021
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