Provider Demographics
NPI:1124340260
Name:HABEGER, RYAN KENT (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KENT
Last Name:HABEGER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4603
Mailing Address - Country:US
Mailing Address - Phone:641-423-5178
Mailing Address - Fax:641-424-0975
Practice Address - Street 1:2006 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4603
Practice Address - Country:US
Practice Address - Phone:641-423-5178
Practice Address - Fax:641-424-0975
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist