Provider Demographics
NPI:1134134778
Name:BRYANS FAMILY PHARMACY
Entity Type:Organization
Organization Name:BRYANS FAMILY PHARMACY
Other - Org Name:BRYANS FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:513-228-0800
Mailing Address - Street 1:726 E MAIN ST
Mailing Address - Street 2:SUITE 29
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1900
Mailing Address - Country:US
Mailing Address - Phone:513-228-0800
Mailing Address - Fax:513-228-0803
Practice Address - Street 1:726 E MAIN ST
Practice Address - Street 2:SUITE 29
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1900
Practice Address - Country:US
Practice Address - Phone:513-228-0800
Practice Address - Fax:513-228-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP02246075003332B00000X
333600000X, 3336C0004X, 3336S0011X
IN64001966A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201342990Medicaid
2078957OtherPK
OH2377253Medicaid
IN201342990Medicaid