Healthcare Provider Details

I. General information

NPI: 1790166056
Provider Name (Legal Business Name): ALEXANDRA RYAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4185 WASHINGTON RD
MC MURRAY PA
15317-2522
US

IV. Provider business mailing address

6039 NATIONAL PIKE
GRINDSTONE PA
15442-1107
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-9111
  • Fax:
Mailing address:
  • Phone: 724-785-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449521
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: