MEDICARE: RYAN JOSEPH EKLUND PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	P7712	ID
2	183500000X	Pharmacist	RPH-0018193	OR

General Provider Information

NPI Number	:	1528444049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JOSEPH EKLUND PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 9200
Second Line	:
City	:	KETCHUM
State	:	ID
Zip	:	83340-7143
Country	:	US
Telephone Number	:	208-726-2596
Fax Number	:

Provider Business Practice Location Address
First Line	:	2790 BROADWAY AVE
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-2216
Country	:	US
Telephone Number	:	541-449-9190
Fax Number	:	541-808-0168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	02/12/2021

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