Provider Demographics
NPI:1578053583
Name:RYBAK, COLIN FRANCIS (RPH)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:FRANCIS
Last Name:RYBAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GOUVENEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642
Mailing Address - Country:US
Mailing Address - Phone:315-287-3600
Mailing Address - Fax:
Practice Address - Street 1:596 U.S. RT 11
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159
Practice Address - Country:US
Practice Address - Phone:315-696-8796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI062555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist