Provider Demographics
NPI:1154927259
Name:BRADT, RYAN NEWEY (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NEWEY
Last Name:BRADT
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 1:1301 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2457
Mailing Address - Country:US
Mailing Address - Phone:636-946-6210
Mailing Address - Fax:
Practice Address - Street 1:1301 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2457
Practice Address - Country:US
Practice Address - Phone:636-946-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020033886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist