Provider Demographics
NPI:1831474139
Name:KRUGER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KRUGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E REPUBLIC RD STE G112
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6026
Mailing Address - Country:US
Mailing Address - Phone:417-987-8029
Mailing Address - Fax:
Practice Address - Street 1:909 E REPUBLIC RD STE G112
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6026
Practice Address - Country:US
Practice Address - Phone:417-883-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist