NPIMap

Individual provider Active NPI

Ryan Thomas Yanicko, PHARM.D.

  • Pharmacist
  • Mooresville, NC
National Provider Identifier
1740565076
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
21998 Issued in NC
Practice address
521 E Plaza Dr
Mooresville, NC 28115-8071
Phone
(704) 658-9870
Fax
(704) 658-9871
NPI assigned
Oct 18, 2011
Last updated
May 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RP446115 PA
Pharmacist 183500000X 21998 NC Primary

Addresses

Primary practice location

521 E Plaza Dr
Mooresville, NC 28115-8071

Mailing address

521 E Plaza Dr
Mooresville, NC 28115-8071
Phone (704) 658-9870

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

LicenseStateTypeSpecialty
RP446115PAMDPharmacist
21998NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cannon Pharmacy Salisbury, LLC Current Accepting new patients
Cannon Pharmacy Salisbury, LLC Current Accepting new patients
Panther Health LLC Past Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620259200000",
    "number": "1740565076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 E PLAZA DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281158071",
            "telephone_number": "704-658-9870",
            "fax_number": "704-658-9871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E PLAZA DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281158071",
            "telephone_number": "704-658-9870",
            "fax_number": "704-658-9871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANICKO",
        "first_name": "RYAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-18",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "PA",
            "license": "RP446115",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "21998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.

Verify at the official NPI Registry.