1922031244 NPI number — J.BRYAN, INC

Table of content: (NPI 1922031244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922031244 NPI number — J.BRYAN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.BRYAN, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922031244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2267
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31203-2267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-741-3718
Provider Business Mailing Address Fax Number:
478-741-6559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 GRAY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31211-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-741-3718
Provider Business Practice Location Address Fax Number:
478-741-6559
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
WADE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHARMACIST/PRESIDENT
Authorized Official Telephone Number:
478-741-3718

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHRE009369 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: PHRE009369 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHRE007469 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00521221B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00521221A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1138278 . This is a "NCPDP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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