Provider Demographics
NPI:1740365972
Name:RITTER, RYAN JAY (DPH (PHARMACIST))
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAY
Last Name:RITTER
Suffix:
Gender:M
Credentials:DPH (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S MISSISSIPPI AVE
Mailing Address - Street 2:P.O. BOX 870
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-3324
Mailing Address - Country:US
Mailing Address - Phone:580-889-3353
Mailing Address - Fax:580-889-3060
Practice Address - Street 1:702 S MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-3324
Practice Address - Country:US
Practice Address - Phone:580-889-3353
Practice Address - Fax:580-889-3060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist