Provider Demographics
NPI:1194329417
Name:RYAN, KERRI L (RPH)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KOCHER DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1923
Mailing Address - Country:US
Mailing Address - Phone:802-442-8369
Mailing Address - Fax:802-447-3174
Practice Address - Street 1:8 KOCHER DR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1923
Practice Address - Country:US
Practice Address - Phone:802-442-8369
Practice Address - Fax:802-447-3174
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23966183500000X
NY050274183500000X
VT3441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist