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General NPI Number Information
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NPI Number | 1255850384
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Entity Type | Individual
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Provider Name | JESSICA HERRY RYU PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 09/09/2017
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Provider Practice Location Address
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Address Line | 1850 CENTRAL AVE
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City | COLONIE
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State | NY
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Zip | 12205-4703
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Country | US
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Telephone | 518-456-1356
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Fax |
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Provider Business Mailing Address
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Address Line | 33 NEW SCOTLAND AVE APT 605
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City | ALBANY
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State | NY
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Zip | 12208-3592
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Country | US
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Telephone | 971-570-2069
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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 | 063410
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License Number State | NY
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