Provider Demographics
NPI:1447857909
Name:BRYAN, MARINDA RENEE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARINDA
Middle Name:RENEE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MARINDA
Other - Middle Name:RENEE
Other - Last Name:HUTCHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2526 HWY 65 S. STE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031
Mailing Address - Country:US
Mailing Address - Phone:501-745-8414
Mailing Address - Fax:501-745-8282
Practice Address - Street 1:2526 HWY 65 S. STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031
Practice Address - Country:US
Practice Address - Phone:501-745-8414
Practice Address - Fax:501-745-8282
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPD11970OtherPHARMACIST LICENSE