MEDICARE: BRYAN WHEELER

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	43416	TN

General Provider Information

NPI Number	:	1659975779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN WHEELER

Provider Business Mailing Address
First Line	:	855 WAYNE RD
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-1974
Country	:	US
Telephone Number	:	731-925-4443
Fax Number	:	731-925-4446

Provider Business Practice Location Address
First Line	:	855 WAYNE RD
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-1974
Country	:	US
Telephone Number	:	731-925-4443
Fax Number	:	731-925-4446

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ BRYAN WHEELER ” Practice Location

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