Provider Demographics
NPI:1710678909
Name:RYAN, JAYNE MARIE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 FRIEDRICH ST
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1222
Mailing Address - Country:US
Mailing Address - Phone:989-306-5358
Mailing Address - Fax:
Practice Address - Street 1:110 S BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-2123
Practice Address - Country:US
Practice Address - Phone:989-734-7392
Practice Address - Fax:989-734-4905
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303026644183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician