Provider Demographics
NPI:1578167938
Name:LOVELY, BRYAN DAVID (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DAVID
Last Name:LOVELY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 BRAYTON POINT RD
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02725-2337
Mailing Address - Country:US
Mailing Address - Phone:774-218-8006
Mailing Address - Fax:
Practice Address - Street 1:1587 BRAYTON POINT RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02725-2337
Practice Address - Country:US
Practice Address - Phone:508-673-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA23298OtherPHARMACIST