Provider Demographics
NPI:1285766170
Name:SMITHBURG, RYAN LEE (RPH)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LEE
Last Name:SMITHBURG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:900 MAIN ST.
Mailing Address - City:LIMON
Mailing Address - State:CO
Mailing Address - Zip Code:80828-0609
Mailing Address - Country:US
Mailing Address - Phone:719-775-2371
Mailing Address - Fax:719-775-9807
Practice Address - Street 1:900 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LIMON
Practice Address - State:CO
Practice Address - Zip Code:80828-0609
Practice Address - Country:US
Practice Address - Phone:719-775-2371
Practice Address - Fax:719-775-9807
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist