Healthcare Provider Details

I. General information

NPI: 1528669991
Provider Name (Legal Business Name): JOHN RYDMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W159S6530 MOORLAND RD
MUSKEGO WI
53150-7515
US

IV. Provider business mailing address

W159S6530 MOORLAND RD
MUSKEGO WI
53150-7515
US

V. Phone/Fax

Practice location:
  • Phone: 414-209-0324
  • Fax:
Mailing address:
  • Phone: 414-209-0324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19131-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: