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NPI Code Detail

MEDICARE: RYAN WHEELER

MEDICARE: RYAN WHEELER
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
1183500000XPharmacist26197NC

General Provider Information

NPI Number : 1255885133
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN WHEELER
Provider Business Mailing Address
First Line : 107 POPLAR RD
Second Line :
City : HAVELOCK
State : NC
Zip : 28532-2720
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 COMMERCE DR
Second Line :
City : NEW BERN
State : NC
Zip : 28562-2213
Country : US
Telephone Number : 252-639-9006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2016
Last Update Date : 08/09/2016

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