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NPI Code Detail

MEDICARE: RYAN LILLY

MEDICARE: RYAN LILLY
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 Program
2183500000XPharmacist2021033960MO

General Provider Information

NPI Number : 1356705917
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN LILLY
Provider Business Mailing Address
First Line : 2301 HOLMES ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-2640
Country : US
Telephone Number : 816-471-2072
Fax Number : 816-471-7123
Provider Business Practice Location Address
First Line : 2340 HAMPTON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63139-2935
Country : US
Telephone Number : 314-647-1256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2016
Last Update Date : 09/24/2023

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Directions to “ RYAN LILLY ” Practice Location

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