Healthcare Provider Details

I. General information

NPI: 1801560396
Provider Name (Legal Business Name): RYAN MCKIERNAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 S RURAL RD
TEMPE AZ
85284-4116
US

IV. Provider business mailing address

3866 S MAPLE DR
GILBERT AZ
85297-0062
US

V. Phone/Fax

Practice location:
  • Phone: 480-783-6233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS025263
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: