Provider Demographics
NPI:1598498149
Name:BERNHARDT, RYAN JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:BERNHARDT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 W LAKE ST UNIT 610
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-5118
Mailing Address - Country:US
Mailing Address - Phone:701-390-0078
Mailing Address - Fax:
Practice Address - Street 1:4880 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:HILLTOP
Practice Address - State:MN
Practice Address - Zip Code:55421-2630
Practice Address - Country:US
Practice Address - Phone:763-571-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist