MEDICARE: RYAN KASSMEIER PHARM D, RPH

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	15856	CO

General Provider Information

NPI Number	:	1629352794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN KASSMEIER PHARM D, RPH

Provider Business Mailing Address
First Line	:	13801 E YALE AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-2337
Country	:	US
Telephone Number	:	720-748-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	13801 E YALE AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-2337
Country	:	US
Telephone Number	:	720-748-0967
Fax Number	:

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

Provider Enumeration Date	:	10/06/2011
Last Update Date	:	03/21/2012

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