Provider Demographics
NPI:1467736611
Name:STONEKING, RYAN DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:STONEKING
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 1:228 NE JEFFERSON AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3802
Mailing Address - Country:US
Mailing Address - Phone:309-285-8231
Mailing Address - Fax:309-676-0832
Practice Address - Street 1:228 NE JEFFERSON AVE STE 207
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3802
Practice Address - Country:US
Practice Address - Phone:309-285-8231
Practice Address - Fax:309-676-0832
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist