Provider Demographics
NPI:1821695719
Name:HUMPHREY, RYAN LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
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 1:5265 RAGAN DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-1237
Mailing Address - Country:US
Mailing Address - Phone:972-948-3935
Mailing Address - Fax:
Practice Address - Street 1:1117 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JEWETT
Practice Address - State:TX
Practice Address - Zip Code:75846-7584
Practice Address - Country:US
Practice Address - Phone:903-626-5414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist