Provider Demographics
NPI:1063596385
Name:LOVY, BRYAN LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:LEE
Last Name:LOVY
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 1:27686 SUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3566
Mailing Address - Country:US
Mailing Address - Phone:248-552-1945
Mailing Address - Fax:
Practice Address - Street 1:25190 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HTS
Practice Address - State:MI
Practice Address - Zip Code:48125-2009
Practice Address - Country:US
Practice Address - Phone:313-292-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024023OtherPHARMACIST LICENSE NUMBER