Provider Demographics
NPI:1881826436
Name:MCGILL, BRYAN S (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:MCGILL
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 ALGONQUIN DR
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1721
Mailing Address - Country:US
Mailing Address - Phone:860-245-5640
Mailing Address - Fax:
Practice Address - Street 1:78 ALGONQUIN DR
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1721
Practice Address - Country:US
Practice Address - Phone:860-245-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00112961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist