Provider Demographics
NPI:1821694910
Name:RYAN, KAITLYN TAMMY (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:TAMMY
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-3015
Mailing Address - Country:US
Mailing Address - Phone:716-875-0922
Mailing Address - Fax:716-875-0430
Practice Address - Street 1:1625 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14207-3015
Practice Address - Country:US
Practice Address - Phone:716-875-0922
Practice Address - Fax:716-875-0430
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist