Provider Demographics
NPI:1801936158
Name:CRAIN, BRYAN K (CPHT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:K
Last Name:CRAIN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:629 HENDERSON FALLS RD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1635
Mailing Address - Country:US
Mailing Address - Phone:864-280-6478
Mailing Address - Fax:864-647-2906
Practice Address - Street 1:132 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1753
Practice Address - Country:US
Practice Address - Phone:864-647-5941
Practice Address - Fax:864-647-2906
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10689183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10689OtherPHARMACY TECH REGISTRATIO
SC290101040758996OtherPHARM TECH CERTIFICATION