Provider Demographics
NPI:1679081558
Name:FREYE, RYAN RICHARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RICHARD
Last Name:FREYE
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 1:4122 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9228
Mailing Address - Country:US
Mailing Address - Phone:231-943-4017
Mailing Address - Fax:231-943-3586
Practice Address - Street 1:4122 US HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9228
Practice Address - Country:US
Practice Address - Phone:231-943-4017
Practice Address - Fax:231-943-3586
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302039891OtherPHARMACIST LICENSE