Russell, Ryan Michael

Russell, Ryan Michael is an sole proprietor health care provider with primary practice located at 12266 De Paul Dr Suite 105, Bridgeton MO 63044-2514. He recently has only one registered license in Pharmacy Service Providers / Pharmacist, which is considered as his primary health care specialty. Russell, Ryan Michael can be contacted via phone (314) 344-7300.

Contact Information

Primary practice address
12266 De Paul Dr Suite 105 Bridgeton MO 63044-2514
Phone: (314) 344-7300
Fax: (314) 344-7179
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Pharmacy Service Providers / Pharmacist 183500000X 2006024046 Missouri
Pharmacy Service Providers / Pharmacist 183500000X 051287298 Illinois

Profile Details

NPI number 1245465467
LBN Legal business name Russell, Ryan Michael
Credentials PHARMD.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 18th, 2009
Last updated Dec 21st, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245465467 NPPES
Missouri MEDICAID 606172302

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