Healthcare Provider Details

I. General information

NPI: 1578995361
Provider Name (Legal Business Name): RYAN IMEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27101-3006
US

IV. Provider business mailing address

1200 N MARTIN LUTHER KING JR DR
WINSTON SALEM NC
27101-3006
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-9800
  • Fax:
Mailing address:
  • Phone: 336-713-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.295808
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212180
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number31580
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: