MEDICARE: RYAN PRINTY

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	183500000X	Pharmacist	016148	KY
2	183500000X	Pharmacist	03132253	OH

General Provider Information

NPI Number	:	1407248925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN PRINTY

Provider Business Mailing Address
First Line	:	2150 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-331-0078
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 DIXIE HWY
Second Line	:
City	:	FORT MITCHELL
State	:	KY
Zip	:	41017-2902
Country	:	US
Telephone Number	:	859-331-0078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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Directions to “ RYAN PRINTY ” Practice Location

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