Provider Demographics
NPI:1912506163
Name:KAAS, ROBERT RYAN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RYAN
Last Name:KAAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 BLUE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-2373
Mailing Address - Country:US
Mailing Address - Phone:608-358-7486
Mailing Address - Fax:
Practice Address - Street 1:130 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN DELLS
Practice Address - State:WI
Practice Address - Zip Code:53965-8263
Practice Address - Country:US
Practice Address - Phone:608-253-5662
Practice Address - Fax:608-253-9682
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist