Provider Demographics
NPI:1912381542
Name:POLLOCK, BRIAN KENNETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KENNETH
Last Name:POLLOCK
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 1:134 HIRAM COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2415
Mailing Address - Country:US
Mailing Address - Phone:440-465-3289
Mailing Address - Fax:
Practice Address - Street 1:1900 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1017
Practice Address - Country:US
Practice Address - Phone:937-332-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist