Provider Demographics
NPI:1740559319
Name:RYAN, LAURENCE N (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:N
Last Name:RYAN
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 1:11343 US HIGHWAY 319 N
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-3419
Mailing Address - Country:US
Mailing Address - Phone:229-226-5424
Mailing Address - Fax:229-226-5048
Practice Address - Street 1:11343 US HIGHWAY 319 N
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-3419
Practice Address - Country:US
Practice Address - Phone:229-226-5424
Practice Address - Fax:229-226-5048
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019259183500000X
FLPS 33638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA014505577AMedicaid