Provider Demographics
NPI:1225690985
Name:BILLMAN, RYAN TAYLOR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:TAYLOR
Last Name:BILLMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 52ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3999
Mailing Address - Country:US
Mailing Address - Phone:262-658-0902
Mailing Address - Fax:
Practice Address - Street 1:4100 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3999
Practice Address - Country:US
Practice Address - Phone:262-658-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18849-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist