Provider Demographics
NPI:1235732967
Name:THACKER, BRIAN DOUGLAS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:THACKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 W PLANE ST
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-9568
Mailing Address - Country:US
Mailing Address - Phone:513-734-6242
Mailing Address - Fax:513-734-1789
Practice Address - Street 1:592 W PLANE ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-9568
Practice Address - Country:US
Practice Address - Phone:513-734-6242
Practice Address - Fax:513-734-1789
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist