Provider Demographics
NPI:1376824102
Name:RYAN, DON MONROE
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:MONROE
Last Name:RYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HIGHWAY 90 EAST
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380
Mailing Address - Country:US
Mailing Address - Phone:985-395-6181
Mailing Address - Fax:
Practice Address - Street 1:1301 HIGHWAY 90 EAST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380
Practice Address - Country:US
Practice Address - Phone:985-395-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.010311183500000X
LAMA.001425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist