Provider Demographics
NPI:1740591676
Name:JEAN, JAMES BRYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYAN
Last Name:JEAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19573 GIBRALTAR CT
Mailing Address - Street 2:
Mailing Address - City:HILMAR
Mailing Address - State:CA
Mailing Address - Zip Code:95324-9650
Mailing Address - Country:US
Mailing Address - Phone:209-648-3116
Mailing Address - Fax:
Practice Address - Street 1:1158 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4523
Practice Address - Country:US
Practice Address - Phone:209-383-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist