Provider Demographics
NPI:1306139738
Name:HART, RYAN (PHARM D)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 S HIGHWAY 127 # 2
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4268
Mailing Address - Country:US
Mailing Address - Phone:270-866-2226
Mailing Address - Fax:270-866-6634
Practice Address - Street 1:183 S HIGHWAY 127 # 2
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4268
Practice Address - Country:US
Practice Address - Phone:270-866-2226
Practice Address - Fax:270-866-6634
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist