Healthcare Provider Details

I. General information

NPI: 1497388201
Provider Name (Legal Business Name): RYAN LEE BURKHART RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 WILMINGTON PIKE
CENTERVILLE OH
45459-7010
US

IV. Provider business mailing address

6480 WILMINGTON PIKE
CENTERVILLE OH
45459-7010
US

V. Phone/Fax

Practice location:
  • Phone: 937-848-5985
  • Fax: 937-848-6769
Mailing address:
  • Phone: 937-848-5985
  • Fax: 937-848-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03223171
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: