Provider Demographics
NPI:1508207077
Name:ALBERT, RYAN MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MARK
Last Name:ALBERT
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 1:1137 LEESBURG DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9486
Mailing Address - Country:US
Mailing Address - Phone:910-371-3295
Mailing Address - Fax:
Practice Address - Street 1:803 N JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2122
Practice Address - Country:US
Practice Address - Phone:910-640-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist