Provider Demographics
NPI:1669498614
Name:BRYANT, WAYNE ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ALAN
Last Name:BRYANT
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 1:408 QUEENSWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1009
Mailing Address - Country:US
Mailing Address - Phone:859-269-8577
Mailing Address - Fax:859-266-4591
Practice Address - Street 1:336 ROMANY RD
Practice Address - Street 2:WHEELER PHARMACY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2404
Practice Address - Country:US
Practice Address - Phone:859-266-1131
Practice Address - Fax:859-266-4591
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist