MEDICARE: EMMA KAY RYAN

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	122350	MN

General Provider Information

NPI Number	:	1578161386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA KAY RYAN

Provider Business Mailing Address
First Line	:	534 TOMLYN AVE
Second Line	:
City	:	SHOREVIEW
State	:	MN
Zip	:	55126-6013
Country	:	US
Telephone Number	:	651-233-6497
Fax Number	:

Provider Business Practice Location Address
First Line	:	4369 BALL RD NE
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-2209
Country	:	US
Telephone Number	:	763-784-0862
Fax Number	:

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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Directions to “ EMMA KAY RYAN ” Practice Location

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