Active NPI
Ryan Mathew Waterbury
- Pharmacist
- Iowa City, IA
National Provider Identifier
1104025253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19532
- Practice address
- 1201 N Dodge St
Iowa City, IA 52245-6105 - Phone
- (319) 337-6323
- Fax
- (319) 337-2037
- NPI assigned
- Jul 17, 2007
- 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 | 19532 | IA | Primary |
Addresses
Primary practice location
1201 N Dodge St
Iowa City, IA 52245-6105
Mailing address
1201 N Dodge St
Iowa City, IA 52245-6105
Phone (319) 337-6323
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 |
|---|---|---|---|
| 19532 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184630400000",
"number": "1104025253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 N DODGE ST",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522456105",
"telephone_number": "319-337-6323",
"fax_number": "319-337-2037"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 N DODGE ST",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522456105",
"telephone_number": "319-337-6323",
"fax_number": "319-337-2037"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERBURY",
"first_name": "RYAN",
"middle_name": "MATHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "19532",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.