Provider Demographics
NPI:1790738383
Name:BRYANT PHARMACY & SUPPLY
Entity Type:Organization
Organization Name:BRYANT PHARMACY & SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-202-8394
Mailing Address - Street 1:104A NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-3512
Mailing Address - Country:US
Mailing Address - Phone:864-716-0018
Mailing Address - Fax:864-844-9085
Practice Address - Street 1:1901 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-0711
Practice Address - Fax:864-226-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMCARE033170001332B00000X
SCSCMCAIDDMES04332B00000X
332B00000X
SCS0004005333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDME504Medicaid
GA000863574YMedicaid
SC0331070001Medicare ID - Type Unspecified