Provider Demographics
NPI:1255850384
Name:RYU, JESSICA HERRY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HERRY
Last Name:RYU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 NEW SCOTLAND AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3592
Mailing Address - Country:US
Mailing Address - Phone:971-570-2069
Mailing Address - Fax:
Practice Address - Street 1:1850 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-4703
Practice Address - Country:US
Practice Address - Phone:518-456-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist