Provider Demographics
NPI:1962022897
Name:MCCANN, RYAN LEONARD
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LEONARD
Last Name:MCCANN
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 1:39W193 E BURNHAM LN
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4878
Mailing Address - Country:US
Mailing Address - Phone:630-797-1851
Mailing Address - Fax:
Practice Address - Street 1:150 E PIERCE RD STE 400
Practice Address - Street 2:
Practice Address - City:ITASCA
Practice Address - State:IL
Practice Address - Zip Code:60143-1231
Practice Address - Country:US
Practice Address - Phone:630-948-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.292491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist