Provider Demographics
NPI:1790900462
Name:THELIN, RYAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:THELIN
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 1:1806 BRADLEY TER
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2905
Mailing Address - Country:US
Mailing Address - Phone:732-718-2865
Mailing Address - Fax:
Practice Address - Street 1:800 W DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1413
Practice Address - Country:US
Practice Address - Phone:732-718-2865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02813100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist