MEDICARE: JOHN C RYAN CPHT

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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1679831580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C RYAN CPHT

Provider Business Mailing Address
First Line	:	7501 TRINITY PEAK ST
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9035
Country	:	US
Telephone Number	:	702-243-8730
Fax Number	:

Provider Business Practice Location Address
First Line	:	7501 TRINITY PEAK ST
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-9035
Country	:	US
Telephone Number	:	702-243-8730
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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