Provider Demographics
NPI:1700299971
Name:PRAGER, RYAN M
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:M
Last Name:PRAGER
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 1:1643 COVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6339
Mailing Address - Country:US
Mailing Address - Phone:215-595-6373
Mailing Address - Fax:
Practice Address - Street 1:600 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1400
Practice Address - Country:US
Practice Address - Phone:215-295-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist