Healthcare Provider Details

I. General information

NPI: 1235442609
Provider Name (Legal Business Name): RYAN RICHARD SOUCY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 BROADWAY
BANGOR ME
04401-3225
US

IV. Provider business mailing address

713 BROADWAY
BANGOR ME
04401-3225
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-5521
  • Fax: 207-990-4411
Mailing address:
  • Phone: 207-942-5521
  • Fax: 207-990-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPR5052
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: