Provider Demographics
NPI:1306130364
Name:KILIANY, RYAN (RPH)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KILIANY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 CHESTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5003
Mailing Address - Country:US
Mailing Address - Phone:704-965-3106
Mailing Address - Fax:
Practice Address - Street 1:3333 PINEVILLE MATTHEWS ROAD
Practice Address - Street 2:HARRIS TEETER PHARMACY #30
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-544-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14490183500000X
PARP044556T183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist