Provider Demographics
NPI:1912349796
Name:RYZNAR, THEODORE LARRY (R PH)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:LARRY
Last Name:RYZNAR
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1850
Mailing Address - Country:US
Mailing Address - Phone:814-827-2386
Mailing Address - Fax:
Practice Address - Street 1:110 S MARTIN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1850
Practice Address - Country:US
Practice Address - Phone:814-827-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029655L183500000X
PARP1003265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist