Provider Demographics
NPI:1013290352
Name:BRYAN, GREG ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:ALAN
Last Name:BRYAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 CRATER LAKE HWY
Mailing Address - Street 2:PHARMACY
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9259
Mailing Address - Country:US
Mailing Address - Phone:541-734-2482
Mailing Address - Fax:541-734-3209
Practice Address - Street 1:3639 CRATER LAKE HWY
Practice Address - Street 2:PHARMACY
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9259
Practice Address - Country:US
Practice Address - Phone:541-734-2482
Practice Address - Fax:541-734-3209
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9251183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist