Provider Demographics
NPI:1073024345
Name:PAYNE, RYAN TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TYLER
Last Name:PAYNE
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 1:235 BONITA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4921
Mailing Address - Country:US
Mailing Address - Phone:724-961-3459
Mailing Address - Fax:
Practice Address - Street 1:1000 LINCOLN PL
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1251
Practice Address - Country:US
Practice Address - Phone:724-850-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist