Provider Demographics
NPI:1083996151
Name:SHULTZ, BRYAN K (RPH)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:K
Last Name:SHULTZ
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 1:3630 S WANAMAKER
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4528
Mailing Address - Country:US
Mailing Address - Phone:785-228-5656
Mailing Address - Fax:785-228-5644
Practice Address - Street 1:3630 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4528
Practice Address - Country:US
Practice Address - Phone:785-228-5656
Practice Address - Fax:785-228-5644
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist