MEDICARE: DENNIS BRYAN RPH MBA FAPHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1568461119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS BRYAN RPH MBA FAPHA

Provider Business Mailing Address
First Line	:	2240 W IOWA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4843
Country	:	US
Telephone Number	:	773-384-6291
Fax Number	:	773-384-0294

Provider Business Practice Location Address
First Line	:	454 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1727
Country	:	US
Telephone Number	:	312-274-1706
Fax Number	:	312-274-1709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	07/08/2007

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