Provider Demographics
NPI:1568461119
Name:BRYAN, DENNIS (RPH MBA FAPHA)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:RPH MBA FAPHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 W IOWA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4843
Mailing Address - Country:US
Mailing Address - Phone:773-384-6291
Mailing Address - Fax:773-384-0294
Practice Address - Street 1:454 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1727
Practice Address - Country:US
Practice Address - Phone:312-274-1706
Practice Address - Fax:312-274-1709
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist