Provider Demographics
NPI:1699386300
Name:DAHN, RYAN LOUIS (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LOUIS
Last Name:DAHN
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 1:1605 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-3071
Mailing Address - Country:US
Mailing Address - Phone:104-326-8453
Mailing Address - Fax:
Practice Address - Street 1:1605 W 7TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-3071
Practice Address - Country:US
Practice Address - Phone:104-326-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist