MEDICARE: DR. RYAN M BLANKS PHARM D

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	PR5726	ME

General Provider Information

NPI Number	:	1811223456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN M BLANKS PHARM D

Provider Business Mailing Address
First Line	:	25 RIVERPLACE DR
Second Line	:	APT. 25-32
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-2086
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 SACO AVE
Second Line	:
City	:	OLD ORCHARD BEACH
State	:	ME
Zip	:	04064-2242
Country	:	US
Telephone Number	:	207-934-1000
Fax Number	:

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

Provider Enumeration Date	:	11/01/2009
Last Update Date	:	11/01/2009

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