Provider Demographics
NPI:1841778511
Name:ROCKWELL, RYAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 HIGHLAND CT
Mailing Address - Street 2:
Mailing Address - City:LAINGSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48848-9770
Mailing Address - Country:US
Mailing Address - Phone:517-614-3377
Mailing Address - Fax:
Practice Address - Street 1:1350 W LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-1314
Practice Address - Country:US
Practice Address - Phone:517-333-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist