Healthcare Provider Details

I. General information

NPI: 1225856412
Provider Name (Legal Business Name): RYAN HEAKIN PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W MAPLE ST
HARTVILLE OH
44632-9671
US

IV. Provider business mailing address

11500 GARDEN LANE AVE NW
UNIONTOWN OH
44685-8537
US

V. Phone/Fax

Practice location:
  • Phone: 330-877-0221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03444556
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: