MEDICARE: DR. RYAN RICHARD PELL 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	RP443892	PA
2	183500000X	Pharmacist	28RI03418200	NJ

General Provider Information

NPI Number	:	1891064119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN RICHARD PELL PHARM.D.

Provider Business Mailing Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:	215-455-6162
Fax Number	:	215-455-6183

Provider Business Practice Location Address
First Line	:	1334 WINDRIM AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19141-2725
Country	:	US
Telephone Number	:	215-455-6162
Fax Number	:	215-455-6183

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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