Provider Demographics
NPI:1205265097
Name:HABEL, BRYCE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:HABEL
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 1:2822 HIGHWAY 414 STE C
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-8913
Mailing Address - Country:US
Mailing Address - Phone:307-786-2222
Mailing Address - Fax:307-786-2223
Practice Address - Street 1:2822 HIGHWAY 414 STE C
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937-8913
Practice Address - Country:US
Practice Address - Phone:307-786-2222
Practice Address - Fax:866-846-7151
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3857183500000X
UT7464381-1701183500000X
ORRPH-0013783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist