Provider Demographics
NPI:1932482866
Name:TAYLOR, RYAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:TAYLOR
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 1:2509 WHITE TAIL DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7222
Mailing Address - Country:US
Mailing Address - Phone:319-553-0206
Mailing Address - Fax:319-553-0210
Practice Address - Street 1:2509 WHITE TAIL DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7222
Practice Address - Country:US
Practice Address - Phone:319-553-0206
Practice Address - Fax:319-553-0210
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739524Medicaid