Provider Demographics
NPI:1588259907
Name:HUYLAR, BRADLEY JAMES
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:HUYLAR
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 1:7216 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-1063
Mailing Address - Country:US
Mailing Address - Phone:307-631-8427
Mailing Address - Fax:
Practice Address - Street 1:1708 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4945
Practice Address - Country:US
Practice Address - Phone:307-829-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist