Provider Demographics
NPI:1558008631
Name:KIEFER, BRYAN THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:THOMAS
Last Name:KIEFER
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 1:106 N FIRST STREET P.O. BOX 739
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-9218
Mailing Address - Country:US
Mailing Address - Phone:573-238-4177
Mailing Address - Fax:573-238-4986
Practice Address - Street 1:106 N FIRST STREET
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-9218
Practice Address - Country:US
Practice Address - Phone:573-238-4177
Practice Address - Fax:573-238-4986
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist