Provider Demographics
NPI:1932235330
Name:RYERSON HEALTHCARE INC
Entity Type:Organization
Organization Name:RYERSON HEALTHCARE INC
Other - Org Name:RYERSON HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:708-877-6950
Mailing Address - Street 1:529 CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1023
Practice Address - Country:US
Practice Address - Phone:708-877-6950
Practice Address - Fax:708-877-6956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
IL333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1478038OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IL=========001Medicaid
1478038OtherOTHER ID NUMBER-COMMERCIAL NUMBER