Provider Demographics
NPI:1528451242
Name:FARRAR, BRYCE (RPH)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:FARRAR
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 1:2911 MILL BAY RD
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-7809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2911 MILL BAY RD
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-7809
Practice Address - Country:US
Practice Address - Phone:907-481-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2315183500000X
MTPHA-PHA-LIC-28356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist