Provider Demographics
NPI:1932480795
Name:RYAN, NATALIE MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MICHELLE
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 1:635 NICKTOWN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-9505
Mailing Address - Country:US
Mailing Address - Phone:815-505-0990
Mailing Address - Fax:
Practice Address - Street 1:1333 PLANK RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8456
Practice Address - Country:US
Practice Address - Phone:815-505-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.290213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist