Provider Demographics
NPI:1386865715
Name:BRILLHART, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BRILLHART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FOX HILL DR
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 FOX HILL DR
Practice Address - Street 2:
Practice Address - City:TABERNACLE
Practice Address - State:NJ
Practice Address - Zip Code:08088-9037
Practice Address - Country:US
Practice Address - Phone:609-268-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI016101001835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy