Provider Demographics
NPI:1124301650
Name:BRYANT, EASTON (PHARMD)
Entity type:Individual
Prefix:
First Name:EASTON
Middle Name:
Last Name:BRYANT
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 1:3058 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9511
Mailing Address - Country:US
Mailing Address - Phone:270-380-1230
Mailing Address - Fax:270-380-1232
Practice Address - Street 1:3058 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-9511
Practice Address - Country:US
Practice Address - Phone:270-380-1230
Practice Address - Fax:270-380-1232
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist