Provider Demographics
NPI:1932482213
Name:BRIAN, BARRY LYNN (DPH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:LYNN
Last Name:BRIAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4058
Mailing Address - Country:US
Mailing Address - Phone:405-377-0349
Mailing Address - Fax:405-377-0169
Practice Address - Street 1:519 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4058
Practice Address - Country:US
Practice Address - Phone:405-377-0349
Practice Address - Fax:405-377-0169
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist