Provider Demographics
NPI:1255724662
Name:KNATZ, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KNATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 EDGEHILL RD S
Mailing Address - Street 2:APT 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1869
Mailing Address - Country:US
Mailing Address - Phone:516-554-6088
Mailing Address - Fax:
Practice Address - Street 1:808 AVIATION PKWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6663
Practice Address - Country:US
Practice Address - Phone:919-460-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist