Provider Demographics
NPI:1205002540
Name:RYBICKI, KEVIN JAMES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:RYBICKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E US HIGHWAY 223
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4454
Mailing Address - Country:US
Mailing Address - Phone:517-265-9686
Mailing Address - Fax:517-265-9870
Practice Address - Street 1:1601 E US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-4454
Practice Address - Country:US
Practice Address - Phone:517-265-9686
Practice Address - Fax:517-265-9870
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032300183500000X
OH03-2-23061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist