MEDICARE: RYAN PHARMACY

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
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301009555	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2375409	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1134419583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN PHARMACY

Provider Business Mailing Address
First Line	:	23421 RYAN RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-1927
Country	:	US
Telephone Number	:	586-755-0040
Fax Number	:	586-755-0044

Provider Business Practice Location Address
First Line	:	23421 RYAN RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48091-1927
Country	:	US
Telephone Number	:	586-755-0040
Fax Number	:	586-755-0044

Authorized Official
Title or Position	:	PHARMACIST
Name	:	RULA YACOUB
Credential	:
Telephone Number	:	586-755-0040

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	07/21/2015

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Directions to “RYAN PHARMACY ” Practice Location

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