Provider Demographics
NPI:1508397993
Name:KAIPONEN, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KAIPONEN
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 1:118 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:ONTONAGON
Mailing Address - State:MI
Mailing Address - Zip Code:49953-9723
Mailing Address - Country:US
Mailing Address - Phone:906-390-0301
Mailing Address - Fax:
Practice Address - Street 1:118 CHERRY LN
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-9723
Practice Address - Country:US
Practice Address - Phone:906-390-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist