Provider Demographics
NPI:1124553821
Name:BRANDEBERRY, RYAN HUNTER
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:HUNTER
Last Name:BRANDEBERRY
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 1:5950 CEDAR POINT RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-5878
Mailing Address - Country:US
Mailing Address - Phone:419-309-0173
Mailing Address - Fax:
Practice Address - Street 1:1415 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2316
Practice Address - Country:US
Practice Address - Phone:419-382-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist