Active NPI
Charles Marvin Bryant Jr.
- Pharmacy Technician
- Pueblo, CO
National Provider Identifier
1518558741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy Technician
- License
- PHATP.0006919
- Practice address
- 2730 S Prairie Ave
Pueblo, CO 81005-3167 - Phone
- (719) 696-6159
- Fax
- (719) 696-6170
- NPI assigned
- Jan 30, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy Technician | 183700000X | PHATP.0006919 | CO | Primary |
Addresses
Primary practice location
2730 S Prairie Ave
Pueblo, CO 81005-3167
Mailing address
1609 Zuni Rd
Pueblo, CO 81001-1620
Phone (719) 568-5009
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | workemail |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHATP.0006919 | CO | MD | Pharmacy Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611964800000",
"number": "1518558741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1609 ZUNI RD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810011620",
"telephone_number": "719-568-5009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2730 S PRAIRIE AVE",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810053167",
"telephone_number": "719-696-6159",
"fax_number": "719-696-6170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRYANT",
"first_name": "CHARLES",
"middle_name": "MARVIN",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-01-30",
"last_updated": "2021-01-30",
"certification_date": "2021-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "183700000X",
"taxonomy_group": "",
"desc": "Pharmacy Technician",
"state": "CO",
"license": "PHATP.0006919",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "workemail",
"affiliation": "N",
"endpointDescription": "cmb00i1.s05828@stores.us.wal-mart.com",
"address_1": "2730 S Prairie Ave",
"city": "Pueblo",
"state": "CO",
"country_code": "US",
"postal_code": "810053167",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.