Provider Demographics
NPI:1538175310
Name:BRYAN, HUBERT RAY JR (RPH)
Entity type:Individual
Prefix:
First Name:HUBERT
Middle Name:RAY
Last Name:BRYAN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRETT
Other - Middle Name:
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:804 GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2018
Mailing Address - Country:US
Mailing Address - Phone:334-347-5111
Mailing Address - Fax:334-347-7100
Practice Address - Street 1:804 GLOVER AVE
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2018
Practice Address - Country:US
Practice Address - Phone:334-347-5111
Practice Address - Fax:334-347-7100
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist