Healthcare Provider Details

I. General information

NPI: 1053922740
Provider Name (Legal Business Name): BRYANT J KAUFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E NELSON ST
LEXINGTON VA
24450-2729
US

IV. Provider business mailing address

422 E NELSON ST
LEXINGTON VA
24450-2729
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-1180
  • Fax: 540-464-1160
Mailing address:
  • Phone: 540-464-1180
  • Fax: 540-464-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0202215252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: