Provider Demographics
NPI:1477740108
Name:RYAN, JOAN MARIE (RPH, BS PHARM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:RPH, BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CATTARAUGUS
Mailing Address - State:NY
Mailing Address - Zip Code:14719-1111
Mailing Address - Country:US
Mailing Address - Phone:716-450-3686
Mailing Address - Fax:
Practice Address - Street 1:19 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6636
Practice Address - Country:US
Practice Address - Phone:716-450-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist