Healthcare Provider Details

I. General information

NPI: 1710901814
Provider Name (Legal Business Name): MARTY RYAN MCKAY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 WATER STREET
LECOMPTE LA
71346-0369
US

IV. Provider business mailing address

9049 HIGHWAY 165 S
WOODWORTH LA
71485-9799
US

V. Phone/Fax

Practice location:
  • Phone: 318-776-5649
  • Fax: 318-776-9212
Mailing address:
  • Phone: 318-443-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10482
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: