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NPI Code Detail

MEDICARE: RYAN BROOKS DAWSON PHARMACIST INTERN

MEDICARE: RYAN BROOKS DAWSON PHARMACIST INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program5351010391MI

General Provider Information

NPI Number : 1073253928
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN BROOKS DAWSON PHARMACIST INTERN
Provider Business Mailing Address
First Line : 5709 S TELEGRAPH RD
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2025
Country : US
Telephone Number : 313-292-1599
Fax Number :
Provider Business Practice Location Address
First Line : 5709 S TELEGRAPH RD
Second Line :
City : DEARBORN HEIGHTS
State : MI
Zip : 48125-2025
Country : US
Telephone Number : 313-292-1599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 03/30/2022

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