=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922031244
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.BRYAN, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 GRAY HWY
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31211-1834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-741-3718
-----------------------------------------------------
Fax | 478-741-6559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2267
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31203-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-741-3718
-----------------------------------------------------
Fax | 478-741-6559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST/PRESIDENT
-----------------------------------------------------
Name | MR. WADE W SCOTT
-----------------------------------------------------
Credential | R.PH.
-----------------------------------------------------
Telephone | 478-741-3718
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number | PHRE009369
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE009369
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------