Provider Demographics
NPI:1356986848
Name:OLLIFF, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OLLIFF
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 1:435 LEWISTON RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4221
Mailing Address - Country:US
Mailing Address - Phone:706-619-3430
Mailing Address - Fax:
Practice Address - Street 1:435 LEWISTON RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-4221
Practice Address - Country:US
Practice Address - Phone:706-619-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-031451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist