MEDICARE: MR. BRYAN LEE LOVY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302024023	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302024023	OTHER	MI	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1063596385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN LEE LOVY RPH

Provider Business Mailing Address
First Line	:	27686 SUTHERLAND ST
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48076-3566
Country	:	US
Telephone Number	:	248-552-1945
Fax Number	:

Provider Business Practice Location Address
First Line	:	25190 VAN BORN RD
Second Line	:
City	:	DEARBORN HTS
State	:	MI
Zip	:	48125-2009
Country	:	US
Telephone Number	:	313-292-2520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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