Provider Demographics
NPI:1790370930
Name:RYAN HEALTH PHARMACY LLC
Entity Type:Organization
Organization Name:RYAN HEALTH PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHACKO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PUTHENTHARAYIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-946-7725
Mailing Address - Street 1:38800 RYAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2993
Mailing Address - Country:US
Mailing Address - Phone:586-983-9652
Mailing Address - Fax:
Practice Address - Street 1:38800 RYAN RD STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2993
Practice Address - Country:US
Practice Address - Phone:586-983-9652
Practice Address - Fax:586-983-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty