Provider Demographics
NPI:1093328825
Name:RAJTER, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:RAJTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 M 89
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1919
Mailing Address - Country:US
Mailing Address - Phone:269-685-5623
Mailing Address - Fax:269-685-5814
Practice Address - Street 1:1277 M 89
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1919
Practice Address - Country:US
Practice Address - Phone:269-685-5623
Practice Address - Fax:269-685-5814
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist