Provider Demographics
NPI:1225311913
Name:TEAGNO, RYAN DEAN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DEAN
Last Name:TEAGNO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 W COOK RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3219
Mailing Address - Country:US
Mailing Address - Phone:260-483-3730
Mailing Address - Fax:260-489-9782
Practice Address - Street 1:1610 W COOK RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3219
Practice Address - Country:US
Practice Address - Phone:260-483-3730
Practice Address - Fax:260-489-9782
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023597A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist