NPI | 1295513950 |
---|---|
Former Name | RYAN AHRENS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: KS 107011) |
Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MO 2023036263) |
Enumeration Date | 2023-09-14 |
Last Update Date | 2023-09-14 |