Provider Demographics
NPI:1356724041
Name:KOLARIK, RYAN JOSEPH (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:KOLARIK
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 1:10504 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4084
Mailing Address - Country:US
Mailing Address - Phone:402-292-0463
Mailing Address - Fax:402-292-6612
Practice Address - Street 1:10504 S 15TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4084
Practice Address - Country:US
Practice Address - Phone:402-292-0463
Practice Address - Fax:402-292-6612
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13620183500000X
IA21524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist