=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669591558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRYANT PHARMACY AND SUPPLY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 N MAIN ST
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29621-3868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-224-0711
-----------------------------------------------------
Fax | 864-226-8331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 NORTH MAIN ST.
-----------------------------------------------------
City | ANDERSON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-225-0990
-----------------------------------------------------
Fax | 864-226-8331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KEVIN LEE BRYANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-224-0711
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 00013661
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------