Healthcare Provider Details

I. General information

NPI: 1649803024
Provider Name (Legal Business Name): RYAN TROUT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 BRIGHTON RD
PITTSBURGH PA
15212-1966
US

IV. Provider business mailing address

3730 BRIGHTON RD
PITTSBURGH PA
15212-1966
US

V. Phone/Fax

Practice location:
  • Phone: 412-761-3363
  • Fax:
Mailing address:
  • Phone: 412-761-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP453719
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: