Provider Demographics
NPI:1912694167
Name:RYAN, SUSAN GRAINGER (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRAINGER
Last Name:RYAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 CAROTHERS PKWY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6300
Mailing Address - Country:US
Mailing Address - Phone:615-771-6446
Mailing Address - Fax:
Practice Address - Street 1:9100 CAROTHERS PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6300
Practice Address - Country:US
Practice Address - Phone:615-771-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist