Provider Demographics
NPI:1952908600
Name:PETERSON, RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:PETERSON
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 1:50 W TECHNE CENTER DR STE J
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9798
Mailing Address - Country:US
Mailing Address - Phone:513-576-8400
Mailing Address - Fax:
Practice Address - Street 1:50 W TECHNE CENTER DR STE J
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-9798
Practice Address - Country:US
Practice Address - Phone:513-576-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034398401835N1003X, 1835P1200X, 208U00000X, 183500000X
333600000X, 3336C0004X, 3336H0001X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy