Provider Demographics
NPI:1699376061
Name:BRYSON, RICK LYNN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:LYNN
Last Name:BRYSON
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 1:400 S FRAN AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-1251
Mailing Address - Country:US
Mailing Address - Phone:660-679-3163
Mailing Address - Fax:660-679-0824
Practice Address - Street 1:400 S FRAN AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-1251
Practice Address - Country:US
Practice Address - Phone:660-679-3163
Practice Address - Fax:660-679-0824
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty