Provider Demographics
NPI:1558917799
Name:HUMPHREY, RYAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:HUMPHREY
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 1:21 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-1241
Mailing Address - Country:US
Mailing Address - Phone:317-852-2763
Mailing Address - Fax:317-858-2952
Practice Address - Street 1:21 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1241
Practice Address - Country:US
Practice Address - Phone:317-852-2763
Practice Address - Fax:317-858-2952
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023276A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist