Provider Demographics
NPI:1770184897
Name:RYBICKI, BRIAN M
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:RYBICKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5130
Mailing Address - Country:US
Mailing Address - Phone:810-357-6824
Mailing Address - Fax:
Practice Address - Street 1:8030 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5130
Practice Address - Country:US
Practice Address - Phone:810-357-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033286183500000X
OH03223424183500000X
KY019156183500000X
CO0020190183500000X
TX57326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist