Provider Demographics
NPI:1215577572
Name:STEFANICH, RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:STEFANICH
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:TRIMBLE
Mailing Address - State:OH
Mailing Address - Zip Code:45782-0158
Mailing Address - Country:US
Mailing Address - Phone:740-767-3851
Mailing Address - Fax:
Practice Address - Street 1:19471 LAKE DR
Practice Address - Street 2:
Practice Address - City:TRIMBLE
Practice Address - State:OH
Practice Address - Zip Code:45782-0158
Practice Address - Country:US
Practice Address - Phone:740-767-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034389081835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist