MEDICARE: RYAN PATRICK MATHEWS PHARMD

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	2022025016	MO

General Provider Information

NPI Number	:	1518695725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN PATRICK MATHEWS PHARMD

Provider Business Mailing Address
First Line	:	1400 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1309
Country	:	US
Telephone Number	:	314-534-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1309
Country	:	US
Telephone Number	:	314-534-3853
Fax Number	:

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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