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General NPI Number Information
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NPI Number | 1699883116
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Entity Type | Organization
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Legal Business Name | BRYAN GREGOR, INC.
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1108 E BLUE EARTH AVE
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City | FAIRMONT
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State | MN
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Zip | 56031-4227
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Country | US
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Telephone | 507-238-4291
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Fax | 507-238-2336
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Provider Business Mailing Address
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Address Line | 1108 E BLUE EARTH AVE
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City | FAIRMONT
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State | MN
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Zip | 56031-4227
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Country | US
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Telephone | 507-238-4291
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Fax | 507-238-2336
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRYAN L GREGOR
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Credential |
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Telephone | 507-238-4291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 259999-1
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License Number State | MN
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