Provider Demographics
NPI:1073700910
Name:RYAN, DEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 OAK CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7004
Mailing Address - Country:US
Mailing Address - Phone:651-426-4439
Mailing Address - Fax:651-286-0899
Practice Address - Street 1:5 EAST COUNTY ROAD B
Practice Address - Street 2:SUITE #2
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117
Practice Address - Country:US
Practice Address - Phone:651-489-2711
Practice Address - Fax:651-286-0899
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist