Healthcare Provider Details

I. General information

NPI: 1356733208
Provider Name (Legal Business Name): RYAN BOKENKOTTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 DELHI AVE
CINCINNATI OH
45238-5343
US

IV. Provider business mailing address

6945 BRITTANY RIDGE LN
CINCINNATI OH
45233-1469
US

V. Phone/Fax

Practice location:
  • Phone: 513-451-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03232794
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016569
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: