Provider Demographics
NPI:1518376177
Name:SYPOLT, RYAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:SYPOLT
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 1:1138 SABBATH HOME RD SW
Mailing Address - Street 2:
Mailing Address - City:HOLDEN BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28462-5364
Mailing Address - Country:US
Mailing Address - Phone:724-977-2129
Mailing Address - Fax:
Practice Address - Street 1:1138 SABBATH HOME RD SW
Practice Address - Street 2:
Practice Address - City:HOLDEN BEACH
Practice Address - State:NC
Practice Address - Zip Code:28462-5364
Practice Address - Country:US
Practice Address - Phone:724-977-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist