Healthcare Provider Details

I. General information

NPI: 1790717759
Provider Name (Legal Business Name): KEVIN PADRIC RYAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4727 DENVER AVENUE SOUTH C/O BARTELL DRUG COMPANY
SEATTLE WA
98134-2316
US

IV. Provider business mailing address

14530 14TH AVE SE
MILL CREEK WA
98012
US

V. Phone/Fax

Practice location:
  • Phone: 206-763-2626
  • Fax: 206-767-1397
Mailing address:
  • Phone: 425-379-0613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00020051
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: