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General NPI Number Information
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NPI Number | 1124476502
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Entity Type | Individual
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Provider Name | RYAN GRIESBAUM
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Gender | Male
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 87 WAGNER RD
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City | MONACA
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State | PA
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Zip | 15061-2421
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Country | US
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Telephone | 724-728-7259
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Fax |
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Provider Business Mailing Address
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Address Line | 87 WAGNER RD
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City | MONACA
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State | PA
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Zip | 15061-2421
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Country | US
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Telephone | 724-728-7259
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 028025
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0009366
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 35644
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 3135423
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 449982
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License Number State | PA
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