Provider Demographics
NPI:1972878957
Name:POLLOCK, BRYAN SCOTT
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:SCOTT
Last Name:POLLOCK
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 1:101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8827
Mailing Address - Country:US
Mailing Address - Phone:870-856-2890
Mailing Address - Fax:870-856-2891
Practice Address - Street 1:101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:AR
Practice Address - Zip Code:72542-8827
Practice Address - Country:US
Practice Address - Phone:870-856-2890
Practice Address - Fax:870-856-2891
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154606614OtherNPI TYPE 2