Provider Demographics
NPI:1700228509
Name:BOLEYN, BRYAN (RPH)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BOLEYN
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 1:11503 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5045
Mailing Address - Country:US
Mailing Address - Phone:865-579-4728
Mailing Address - Fax:865-579-4567
Practice Address - Street 1:11503 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5045
Practice Address - Country:US
Practice Address - Phone:865-579-4728
Practice Address - Fax:865-579-4567
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38753183500000X
KY11050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist