Provider Demographics
NPI:1245682012
Name:MOTTE, RYAN JAMISON (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMISON
Last Name:MOTTE
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 1:10418 EBBETS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4358
Mailing Address - Country:US
Mailing Address - Phone:252-414-0104
Mailing Address - Fax:
Practice Address - Street 1:10012 WEISS WAY
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-0800
Practice Address - Country:US
Practice Address - Phone:704-321-2694
Practice Address - Fax:704-443-9033
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist