MEDICARE: DEREK RYCEK PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26179	NC

General Provider Information

NPI Number	:	1003168873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK RYCEK PHARM.D.

Provider Business Mailing Address
First Line	:	1950 STATE ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-4920
Country	:	US
Telephone Number	:	812-948-8305
Fax Number	:	812-496-3572

Provider Business Practice Location Address
First Line	:	1950 STATE ST
Second Line	:
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-4920
Country	:	US
Telephone Number	:	812-948-8305
Fax Number	:	812-496-3572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	09/02/2022

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