Provider Demographics
NPI:1972100352
Name:BRYANT, REBECCA ERIN (RPH)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ERIN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 HARDYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-8222
Mailing Address - Country:US
Mailing Address - Phone:270-925-1415
Mailing Address - Fax:
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNFORDVILLE
Practice Address - State:KY
Practice Address - Zip Code:42765-9043
Practice Address - Country:US
Practice Address - Phone:270-524-3669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist