Organization
THOMAS C RYAN
Active
Other names
PETERSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS RYAN R PH (OWNER/PIC)
(319) 642-3312
Entity
Organization
Contact information
Practice address
104 E WASHINGTON ST, MARENGO, IA 52301-1545
(319) 642-3312
(319) 741-6011
Mailing address
104 E WASHINGTON ST, MARENGO, IA 52301-1545
(319) 642-3312
(319) 741-6011
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
36
IA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992784870
—
IA
01
—
2028364
PK
—
Enumeration date
01/10/2006
Last updated
12/13/2016
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