Provider Demographics
NPI:1053194548
Name:SULLIVAN, RYAN LEE (PHARM D)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1750
Mailing Address - Country:US
Mailing Address - Phone:330-545-8414
Mailing Address - Fax:
Practice Address - Street 1:713 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1750
Practice Address - Country:US
Practice Address - Phone:330-545-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist