Healthcare Provider Details

I. General information

NPI: 1134535594
Provider Name (Legal Business Name): RYAN LINDENAU PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 ROCHESTER RD
MIDDLEPORT NY
14105-9638
US

IV. Provider business mailing address

PO BOX 188
MIDDLEPORT NY
14105-0188
US

V. Phone/Fax

Practice location:
  • Phone: 716-735-3261
  • Fax:
Mailing address:
  • Phone: 716-735-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059248
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: