Healthcare Provider Details

I. General information

NPI: 1427022474
Provider Name (Legal Business Name): HAROLD RYAN PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 E OAKLAND AVE
BLOOMINGTON IL
61701-5524
US

IV. Provider business mailing address

1118 E OAKLAND AVE
BLOOMINGTON IL
61701-5524
US

V. Phone/Fax

Practice location:
  • Phone: 309-828-4813
  • Fax: 309-828-4922
Mailing address:
  • Phone: 309-828-4813
  • Fax: 309-828-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. DONALD LYNN WEBBER
Title or Position: OWNER
Credential:
Phone: 309-828-4813