Healthcare Provider Details

I. General information

NPI: 1902584956
Provider Name (Legal Business Name): RYBACK CYZR OLAY LOMBOY PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 W GORE BLVD
LAWTON OK
73505-6332
US

IV. Provider business mailing address

6921 W GORE BLVD APT 411
LAWTON OK
73505-5375
US

V. Phone/Fax

Practice location:
  • Phone: 508-280-4445
  • Fax: 580-510-7009
Mailing address:
  • Phone: 870-514-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberR-21513
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16697
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number22858-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: