Provider Demographics
NPI:1760165674
Name:RYAN, SARAH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6404 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-2131
Mailing Address - Country:US
Mailing Address - Phone:816-769-3650
Mailing Address - Fax:
Practice Address - Street 1:3515 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2501
Practice Address - Country:US
Practice Address - Phone:816-753-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-103023183500000X
MO2017034037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist