Healthcare Provider Details

I. General information

NPI: 1245377167
Provider Name (Legal Business Name): BRYAN C MCCUTCHEON RPH, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 ECHO AVE ECHO PHARMACY
MILLER PLACE NY
11764-2401
US

IV. Provider business mailing address

22 STONYWELL CT
DIX HILLS NY
11746-5423
US

V. Phone/Fax

Practice location:
  • Phone: 631-642-8175
  • Fax: 631-642-8178
Mailing address:
  • Phone: 631-499-7685
  • Fax: 631-493-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number030923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: