Active NPI
Michael Ryan
- Pharmacist
- Council Bluffs, IA
National Provider Identifier
1003488826
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 18333
- Practice address
- 1141 N Broadway
Council Bluffs, IA 51503-1513 - Phone
- (712) 322-9019
- Fax
- (712) 325-9731
- NPI assigned
- Jul 12, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 18333 | IA | Primary |
Addresses
Primary practice location
1141 N Broadway
Council Bluffs, IA 51503-1513
Mailing address
1141 N Broadway
Council Bluffs, IA 51503-1513
Phone (712) 322-9019
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | RX12@BRSTORES.COM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18333 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626048000000",
"number": "1003488826",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1141 N BROADWAY",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515031513",
"telephone_number": "712-322-9019",
"fax_number": "712-325-9731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1141 N BROADWAY",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515031513",
"telephone_number": "712-322-9019",
"fax_number": "712-325-9731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-07-12",
"last_updated": "2021-07-12",
"certification_date": "2021-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "18333",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "RX12@BRSTORES.COM",
"affiliation": "N",
"endpointDescription": "PHARMACY",
"address_1": "1141 N Broadway",
"city": "Council Bluffs",
"state": "IA",
"country_code": "US",
"postal_code": "515031513",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.