Healthcare Provider Details

I. General information

NPI: 1710255807
Provider Name (Legal Business Name): RYAN L MEZINGER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 DETROIT AVE
LAKEWOOD OH
44107-3041
US

IV. Provider business mailing address

9574 TABERNA LN
OLMSTED FALLS OH
44138-4257
US

V. Phone/Fax

Practice location:
  • Phone: 216-227-1373
  • Fax:
Mailing address:
  • Phone: 440-476-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03225319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: