=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245156561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRACI BRYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1248 KINNEYS LN
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45662-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-356-7958
-----------------------------------------------------
Fax | 740-356-7956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 GERMANY ROAD
-----------------------------------------------------
City | LUCASVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-356-7958
-----------------------------------------------------
Fax | 740-356-7956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 09306380
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------