Provider Demographics
NPI:1871689919
Name:CORELL, RYAN J (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:CORELL
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 1:621 S ILLINOIS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-422-6940
Mailing Address - Fax:641-422-6942
Practice Address - Street 1:621 S ILLINOIS AVE STE 101
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5489
Practice Address - Country:US
Practice Address - Phone:641-422-6940
Practice Address - Fax:641-422-6942
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist