=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700504677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABINE MARTINE RYAN RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2022
-----------------------------------------------------
Last Update Date | 08/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 SYLVAN AVE
-----------------------------------------------------
City | DELMAR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12054-3334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-258-7004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 STLVAN AVENUE
-----------------------------------------------------
City | DELMAR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-258-7004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 065479
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------