Active NPI
Ryan William Petronis
- Pharmacist
- Waxhaw, NC
National Provider Identifier
1467757526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20583
- Practice address
- 1142 N Broome St
Waxhaw, NC 28173-9378 - Phone
- (704) 843-4680
- NPI assigned
- Jan 21, 2011
- Last updated
- Jan 21, 2011
- 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 | 20583 | NC | Primary |
Addresses
Primary practice location
1142 N Broome St
Waxhaw, NC 28173-9378
Mailing address
222 East Bland St
Apt 433
Charlotte, NC 28209
Phone (518) 588-6099
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 |
|---|---|---|---|
| 20583 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295568000000",
"number": "1467757526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 EAST BLAND ST",
"address_2": "APT 433",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "28209",
"telephone_number": "518-588-6099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1142 N BROOME ST",
"city": "WAXHAW",
"state": "NC",
"postal_code": "281739378",
"telephone_number": "704-843-4680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRONIS",
"first_name": "RYAN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-01-21",
"last_updated": "2011-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "20583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waxhaw, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.