Healthcare Provider Details

I. General information

NPI: 1740591676
Provider Name (Legal Business Name): JAMES BRYAN JEAN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 W MAIN ST
MERCED CA
95340-4523
US

IV. Provider business mailing address

19573 GIBRALTAR CT
HILMAR CA
95324-9650
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-2404
  • Fax:
Mailing address:
  • Phone: 209-648-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: