Provider Demographics
NPI:1922136209
Name:PEOPLES, RYAN PHILLIP
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PHILLIP
Last Name:PEOPLES
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 1:6419 CROSAN DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35023-4355
Mailing Address - Country:US
Mailing Address - Phone:205-497-5011
Mailing Address - Fax:
Practice Address - Street 1:104 RIVER SQUARE PLZ
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1667
Practice Address - Country:US
Practice Address - Phone:205-491-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL14196OtherPHARMACY LICENSE