Provider Demographics
NPI:1912612409
Name:ALSOP, RYAN (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:ALSOP
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 1:850 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-2302
Mailing Address - Country:US
Mailing Address - Phone:435-563-6201
Mailing Address - Fax:435-563-4034
Practice Address - Street 1:850 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-2302
Practice Address - Country:US
Practice Address - Phone:435-563-6201
Practice Address - Fax:435-563-4034
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9284553-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9284553-1701OtherCLINICAL PHARMACIST LICENSE