Healthcare Provider Details

I. General information

NPI: 1740365972
Provider Name (Legal Business Name): RYAN JAY RITTER D.PH. (PHARMACIST)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S MISSISSIPPI AVE
ATOKA OK
74525-3324
US

IV. Provider business mailing address

702 S MISSISSIPPI AVE P.O. BOX 870
ATOKA OK
74525-3324
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-3353
  • Fax: 580-889-3060
Mailing address:
  • Phone: 580-889-3353
  • Fax: 580-889-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12741
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: