Provider Demographics
NPI:1689045007
Name:KERSTAN, RYAN (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KERSTAN
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 1:2234 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1224
Mailing Address - Country:US
Mailing Address - Phone:410-608-2379
Mailing Address - Fax:
Practice Address - Street 1:443 PEWAUKEE RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5886
Practice Address - Country:US
Practice Address - Phone:262-956-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18094-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist