Provider Demographics
NPI:1710255807
Name:MEZINGER, RYAN L (RPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:L
Last Name:MEZINGER
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 1:9574 TABERNA LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-4257
Mailing Address - Country:US
Mailing Address - Phone:440-476-2409
Mailing Address - Fax:
Practice Address - Street 1:11701 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3041
Practice Address - Country:US
Practice Address - Phone:216-227-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03225319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist