Provider Demographics
NPI:1992424998
Name:MICHAEL, RYAN TYLER (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:TYLER
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:NUREMBERG
Mailing Address - State:PA
Mailing Address - Zip Code:18241-0622
Mailing Address - Country:US
Mailing Address - Phone:570-861-2683
Mailing Address - Fax:
Practice Address - Street 1:1000 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-1842
Practice Address - Country:US
Practice Address - Phone:570-450-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP457047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist