MEDICARE: MR. JOHN MICHAEL BRISLIN B.PHARM.,RPH, FIAIHC

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	174400000X	Specialist	8002	KY
2	183500000X	Pharmacist	8002	KY
3	1835P1200X	Pharmacotherapy Pharmacist	8002	KY
4	1835P1300X	Psychiatric Pharmacist	8002	KY
5	1835G0303X	Geriatric Pharmacist	008002	KY

General Provider Information

NPI Number	:	1477553469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MICHAEL BRISLIN B.PHARM.,RPH, FIAIHC

Provider Business Mailing Address
First Line	:	PO BOX 25163
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40524-5163
Country	:	US
Telephone Number	:	859-271-8677
Fax Number	:	866-861-8841

Provider Business Practice Location Address
First Line	:	1096 DUVAL ST
Second Line	:	SUITE J
City	:	LEXINGTON
State	:	KY
Zip	:	40515-6219
Country	:	US
Telephone Number	:	859-271-8677
Fax Number	:	866-861-8841

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

Provider Enumeration Date	:	07/31/2005
Last Update Date	:	01/28/2012

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