Provider Demographics
NPI:1578851564
Name:RYAN, JAMES J (BS RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:RYAN
Suffix:
Gender:M
Credentials:BS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MCDONALD CIR
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3321
Mailing Address - Country:US
Mailing Address - Phone:413-589-1940
Mailing Address - Fax:
Practice Address - Street 1:58 MCDONALD CIR
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3321
Practice Address - Country:US
Practice Address - Phone:413-589-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8152183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist