Healthcare Provider Details

I. General information

NPI: 1790738383
Provider Name (Legal Business Name): BRYANT PHARMACY & SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N MAIN STREET
ANDERSON SC
29621
US

IV. Provider business mailing address

104A NORTH AVE
ANDERSON SC
29625-3512
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-0711
  • Fax: 864-226-8331
Mailing address:
  • Phone: 864-716-0018
  • Fax: 864-844-9085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMCARE033170001
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSCMCAIDDMES04
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberS0004005
License Number StateSC

VIII. Authorized Official

Name: KEVIN BRYANT
Title or Position: PRESIDENT
Credential:
Phone: 864-202-8394