Healthcare Provider Details

I. General information

NPI: 1124253232
Provider Name (Legal Business Name): RYAN R MERRICK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH ST SW 4TH FLOOR
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 SIXTH ST SW 4TH FLOOR
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-4860
  • Fax: 330-363-4001
Mailing address:
  • Phone: 330-363-4860
  • Fax: 330-363-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-1-20345
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: