Healthcare Provider Details

I. General information

NPI: 1669553814
Provider Name (Legal Business Name): RYAN PHILLIP HULL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9576 NC HWY 10W THE DRUG STORE HEALTH MART #2
VALE NC
28168
US

IV. Provider business mailing address

2139 ELLIS HOYLE RD
VALE NC
28168-8445
US

V. Phone/Fax

Practice location:
  • Phone: 704-462-0226
  • Fax: 704-462-0229
Mailing address:
  • Phone: 704-276-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16462
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: