Provider Demographics
NPI:1407140312
Name:GLAZE, RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:GLAZE
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 1:4144 BUCKEYE PKWY
Mailing Address - Street 2:TARGET STORE NUMBER T-2070
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8175
Mailing Address - Country:US
Mailing Address - Phone:614-305-3955
Mailing Address - Fax:614-305-3955
Practice Address - Street 1:4144 BUCKEYE PKWY
Practice Address - Street 2:TARGET STORE NUMBER T-2070
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8175
Practice Address - Country:US
Practice Address - Phone:614-305-3955
Practice Address - Fax:614-305-3955
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-21529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist