Healthcare Provider Details

I. General information

NPI: 1194125088
Provider Name (Legal Business Name): RYAN LEWAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE BLDG 228, ROOM 1041
HINES IL
60141-3030
US

IV. Provider business mailing address

5000 S 5TH AVE BLDG 228, ROOM 1041
HINES IL
60141-3030
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2488
  • Fax: 708-202-4768
Mailing address:
  • Phone: 708-202-2488
  • Fax: 708-202-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051297754
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: