Provider Demographics
NPI:1427155852
Name:FOXX, II, W. J. BRYAN (RPH)
Entity type:Individual
Prefix:
First Name:W. J.
Middle Name:BRYAN
Last Name:FOXX, II
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 1:418 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-3119
Mailing Address - Country:US
Mailing Address - Phone:620-223-5691
Mailing Address - Fax:
Practice Address - Street 1:710 W. 8TH ST.
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-0750
Practice Address - Country:US
Practice Address - Phone:620-223-5200
Practice Address - Fax:620-224-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist