Healthcare Provider Details

I. General information

NPI: 1801936158
Provider Name (Legal Business Name): BRYAN K CRAIN CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MAIN ST
WESTMINSTER SC
29693-1753
US

IV. Provider business mailing address

629 HENDERSON FALLS RD
TOCCOA GA
30577-1635
US

V. Phone/Fax

Practice location:
  • Phone: 864-647-5941
  • Fax: 864-647-2906
Mailing address:
  • Phone: 864-280-6478
  • Fax: 864-647-2906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number10689
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: