Healthcare Provider Details

I. General information

NPI: 1689498180
Provider Name (Legal Business Name): MATTHEW RYAN EARLY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 OAK ST
KENOVA WV
25530
US

IV. Provider business mailing address

100 ROBERTO DR
HUNTINGTON WV
25705-7689
US

V. Phone/Fax

Practice location:
  • Phone: 304-453-3503
  • Fax: 304-453-4681
Mailing address:
  • Phone: 304-972-7578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0014413
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: