Provider Demographics
NPI:1356633788
Name:LEFTWICH, RYAN JACOB (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JACOB
Last Name:LEFTWICH
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 1:4248 COAL HERITAGE RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-9190
Mailing Address - Country:US
Mailing Address - Phone:304-589-6868
Mailing Address - Fax:
Practice Address - Street 1:4248 COAL HERITAGE RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-9190
Practice Address - Country:US
Practice Address - Phone:304-589-6868
Practice Address - Fax:304-589-6905
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209225183500000X
WVRP0007300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist