MEDICARE: BRYAN PHARMACY INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	112343	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0131982	OTHER	AL	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851399596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN PHARMACY INC.

Provider Business Mailing Address
First Line	:	736 GLOVER AVE.
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2018
Country	:	US
Telephone Number	:	334-347-5111
Fax Number	:	334-347-7100

Provider Business Practice Location Address
First Line	:	736 GLOVER AVE
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2018
Country	:	US
Telephone Number	:	334-347-5111
Fax Number	:	334-347-7100

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HUBERT RAY BRYAN JR.
Credential	:	RPH
Telephone Number	:	334-347-5111

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/02/2012

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Directions to “BRYAN PHARMACY INC. ” Practice Location

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