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General NPI Number Information
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NPI Number | 1053533018
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Entity Type | Individual
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Provider Name | RYAN WESLEY RINEY R. PH
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3865 GRAVOIS
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City | ST. LOUIS
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State | MO
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Zip | 63116
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Country | US
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Telephone | 314-771-0218
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Fax | 314-771-4862
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Provider Business Mailing Address
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Address Line | 9010 MAPLE RD
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-633-2580
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Fax | 314-771-4862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2004031545
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License Number State | MO
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