Provider Demographics
NPI:1801165964
Name:BOMBARDIER, BRYAN CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:CHRISTOPHER
Last Name:BOMBARDIER
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 1:124 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2820
Mailing Address - Country:US
Mailing Address - Phone:785-614-3492
Mailing Address - Fax:785-340-3277
Practice Address - Street 1:124 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2820
Practice Address - Country:US
Practice Address - Phone:785-614-3492
Practice Address - Fax:785-340-3277
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist