Provider Demographics
NPI:1982980959
Name:MEYER, BRIAN W (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:MEYER
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 1:1599 BURR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4782
Mailing Address - Country:US
Mailing Address - Phone:319-621-0116
Mailing Address - Fax:
Practice Address - Street 1:2821 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4806
Practice Address - Country:US
Practice Address - Phone:319-365-6306
Practice Address - Fax:319-365-0240
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21010183500000X
IL051.294542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist