Healthcare Provider Details

I. General information

NPI: 1275932196
Provider Name (Legal Business Name): RYAN LOEHR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 COMMERCIAL ST
WARSAW MO
65355-3431
US

IV. Provider business mailing address

1330 COMMERCIAL ST
WARSAW MO
65355-3431
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-7331
  • Fax:
Mailing address:
  • Phone: 660-438-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014025406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: