Provider Demographics
NPI:1821760992
Name:WHALEN, RYAN MATTHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:WHALEN
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 1:816 SLATTERY RD
Mailing Address - Street 2:
Mailing Address - City:EAST FAIRFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05448-9791
Mailing Address - Country:US
Mailing Address - Phone:802-849-9372
Mailing Address - Fax:
Practice Address - Street 1:816 SLATTERY RD
Practice Address - Street 2:
Practice Address - City:EAST FAIRFIELD
Practice Address - State:VT
Practice Address - Zip Code:05448-9791
Practice Address - Country:US
Practice Address - Phone:802-849-9372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0134584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist