Provider Demographics
NPI:1518196963
Name:RYAN, KELLY MICHELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MICHELLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-9553
Mailing Address - Country:US
Mailing Address - Phone:785-550-0264
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD BLDG 9
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-2686
Practice Address - Country:US
Practice Address - Phone:785-350-1582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2018-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38850183500000X
KS1-15211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist