Provider Demographics
NPI:1407486137
Name:BRYANT, JENNIFER M (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 BRYAN STATION RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-2138
Mailing Address - Country:US
Mailing Address - Phone:859-293-6476
Mailing Address - Fax:859-293-6861
Practice Address - Street 1:1650 BRYAN STATION RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-2138
Practice Address - Country:US
Practice Address - Phone:859-293-6476
Practice Address - Fax:859-293-6861
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0112981835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist