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General NPI Number Information
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NPI Number | 1205750874
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Entity Type | Individual
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Provider Name | MIKAYLA LYNN RYAN
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Gender | Female
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 935 SHELBURNE RD
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City | SOUTH BURLINGTON
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State | VT
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Zip | 05403-6991
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Country | US
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Telephone | 802-863-1842
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ELLYN LN
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City | TROY
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State | NY
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Zip | 12182-1006
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Country | US
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Telephone | 518-390-1007
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Fax |
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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 | 033.0136133
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License Number State | VT
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