MEDICARE: RYAN PINKSTON

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	57014	TX

General Provider Information

NPI Number	:	1619572781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN PINKSTON

Provider Business Mailing Address
First Line	:	3700 PINE TREE RD
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-9687
Country	:	US
Telephone Number	:	409-540-9774
Fax Number	:

Provider Business Practice Location Address
First Line	:	4006 ESTES PKWY
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75603-1712
Country	:	US
Telephone Number	:	903-234-2083
Fax Number	:

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

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/05/2020

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Directions to “ RYAN PINKSTON ” Practice Location

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