Provider Demographics
NPI:1922031244
Name:J.BRYAN, INC
Entity Type:Organization
Organization Name:J.BRYAN, INC
Other - Org Name:SCOTT'S PHARMACY # 2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-741-3718
Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31203-2267
Mailing Address - Country:US
Mailing Address - Phone:478-741-3718
Mailing Address - Fax:478-741-6559
Practice Address - Street 1:900 GRAY HWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1834
Practice Address - Country:US
Practice Address - Phone:478-741-3718
Practice Address - Fax:478-741-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0093693336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE007469OtherBOARD OF PHARMACY
GA00521221BMedicaid
GA00521221AMedicaid
GA1138278OtherNCPDP
GA1138278OtherNCPDP
GABT3460184OtherDEA
GA00521221BMedicaid