Provider Demographics
NPI:1477635266
Name:BRYAN FAMILY PHARMACY
Entity Type:Organization
Organization Name:BRYAN FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM
Authorized Official - Phone:225-978-4671
Mailing Address - Street 1:17275 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:GROSSE TETE
Mailing Address - State:LA
Mailing Address - Zip Code:70740-3008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17275 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:GROSSE TETE
Practice Address - State:LA
Practice Address - Zip Code:70740-3008
Practice Address - Country:US
Practice Address - Phone:225-648-2020
Practice Address - Fax:225-648-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2009IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1256455Medicaid
1921572OtherOTHER ID NUMBER-COMMERCIAL NUMBER