Provider Demographics
NPI:1588988836
Name:RYAN, CARRIE L (RPH)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
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 1:8066 SOULE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-3538
Mailing Address - Country:US
Mailing Address - Phone:315-865-6370
Mailing Address - Fax:
Practice Address - Street 1:8066 SOULE RD
Practice Address - Street 2:
Practice Address - City:HOLLAND PATENT
Practice Address - State:NY
Practice Address - Zip Code:13354-3538
Practice Address - Country:US
Practice Address - Phone:315-865-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist