Provider Demographics
NPI:1316339922
Name:CLEMENS, RYAN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CLEMENS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6165 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6338
Mailing Address - Country:US
Mailing Address - Phone:513-719-2420
Mailing Address - Fax:513-719-2455
Practice Address - Street 1:6165 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6338
Practice Address - Country:US
Practice Address - Phone:513-719-2420
Practice Address - Fax:513-719-2455
Is Sole Proprietor?:No
Enumeration Date:2015-02-19
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY014218183500000X, 1835P0018X
OH03328892183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist