Healthcare Provider Details

I. General information

NPI: 1134134778
Provider Name (Legal Business Name): BRYANS FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 E MAIN ST SUITE 29
LEBANON OH
45036-1900
US

IV. Provider business mailing address

726 E MAIN ST SUITE 29
LEBANON OH
45036-1900
US

V. Phone/Fax

Practice location:
  • Phone: 513-228-0800
  • Fax: 513-228-0803
Mailing address:
  • Phone: 513-228-0800
  • Fax: 513-228-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberRTP02246075003
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number64001966A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON SMITH
Title or Position: PRESIDENT
Credential: BSPHARM
Phone: 513-228-0800