Provider Demographics
NPI:1043645278
Name:BRIAN, PATRICK KENNETH (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:KENNETH
Last Name:BRIAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 FLORIDA AVE SE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-3728
Mailing Address - Country:US
Mailing Address - Phone:225-665-5186
Mailing Address - Fax:225-665-8633
Practice Address - Street 1:257 FLORIDA AVE SE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-3728
Practice Address - Country:US
Practice Address - Phone:225-665-5186
Practice Address - Fax:225-665-8633
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11024183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist