| Doctor Name: | DR. RYAN BLAKE PROVINCE |
| NPI Number: | 1134592454 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD |
| License Number: | 1-16504 |
| Business Practice Address: | 4101 S 4th St Leavenworth, KS - 660485014 |
| Business Phone Number: | 9136822000 |
| Business Fax Number: | |
| Mailing Address: | 4101 S 4th St, LEAVENWORTH |
| State: | KS |
| Postal Code: | 660485014 |
| Phone Number: | 9136822000 |
| Fax Number: | |
| NPI Enumeration Date: | 11/09/2015 |
| NPI Last Update Date: | 11/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | 1-16504 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |