Provider Demographics
NPI:1336589597
Name:RILEY, RYAN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:D
Last Name:RILEY
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 1:8100 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8019
Mailing Address - Country:US
Mailing Address - Phone:614-322-9706
Mailing Address - Fax:614-328-4941
Practice Address - Street 1:8100 E BROAD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8019
Practice Address - Country:US
Practice Address - Phone:614-322-9706
Practice Address - Fax:614-328-4941
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232937-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist