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General NPI Number Information
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NPI Number | 1912349796
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Entity Type | Individual
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Provider Name | THEODORE LARRY RYZNAR R .PH.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 110 S MARTIN ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-1850
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Country | US
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Telephone | 814-827-2386
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Fax |
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Provider Business Mailing Address
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Address Line | 110 S MARTIN ST
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City | TITUSVILLE
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State | PA
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Zip | 16354-1850
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Country | US
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Telephone | 814-827-2386
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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 | RP029655L
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License Number State | PA
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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 | RP1003265
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License Number State | PA
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