Healthcare Provider Details

I. General information

NPI: 1346161254
Provider Name (Legal Business Name): RYAN MICHAEL BOOTH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

3304 COMMODORE DR APT 496
LEXINGTON KY
40502-3650
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax:
Mailing address:
  • Phone: 859-494-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number022970
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: