Healthcare Provider Details

I. General information

NPI: 1437767647
Provider Name (Legal Business Name): RYAN PAUL VANSICE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

97 LONG MEADOW CIR
PITTSFORD NY
14534-1119
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 585-690-6247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number066731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: