Active NPI
Ryan Patrick Mavis, PHARMD
- Pharmacist
- Ada, OK
National Provider Identifier
1174172753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- R-18469
- Practice address
- 1005 Arlington St
Ada, OK 74820-4036 - Phone
- (580) 272-0283
- NPI assigned
- Sep 6, 2019
- Sex
- Male
- Sole proprietor
- No
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 | R-18469 | OK | Primary |
Addresses
Primary practice location
1005 Arlington St
Ada, OK 74820-4036
Mailing address
309 Potomac Dr
Norman, OK 73072-4536
Phone (405) 808-7972
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-18469 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1567728000000",
"number": "1174172753",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "309 POTOMAC DR",
"city": "NORMAN",
"state": "OK",
"postal_code": "730724536",
"telephone_number": "405-808-7972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 ARLINGTON ST",
"city": "ADA",
"state": "OK",
"postal_code": "748204036",
"telephone_number": "580-272-0283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAVIS",
"first_name": "RYAN",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-06",
"last_updated": "2019-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "R-18469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ada, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.