Provider Demographics
NPI:1003361809
Name:HINES, RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HINES
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 1:30182 SUSSEX HWY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3884
Mailing Address - Country:US
Mailing Address - Phone:302-875-8560
Mailing Address - Fax:
Practice Address - Street 1:30182 SUSSEX HWY UNIT 1
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-3884
Practice Address - Country:US
Practice Address - Phone:302-875-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24404183500000X
DEA10004983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist