Provider Demographics
NPI:1477553469
Name:BRISLIN, JOHN MICHAEL (BPHARM,RPH, FIAIHC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BRISLIN
Suffix:
Gender:M
Credentials:BPHARM,RPH, FIAIHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25163
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-5163
Mailing Address - Country:US
Mailing Address - Phone:859-271-8677
Mailing Address - Fax:866-861-8841
Practice Address - Street 1:1096 DUVAL ST
Practice Address - Street 2:SUITE J
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6219
Practice Address - Country:US
Practice Address - Phone:859-271-8677
Practice Address - Fax:866-861-8841
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-31
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8002174400000X, 183500000X, 1835P1200X, 1835P1300X
KY0080021835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No174400000XOther Service ProvidersSpecialist
No183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric