MEDICARE: DR. RYAN GLAZE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-21529	OH

General Provider Information

NPI Number	:	1407140312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN GLAZE PHARMD

Provider Business Mailing Address
First Line	:	4144 BUCKEYE PKWY
Second Line	:	TARGET STORE NUMBER T-2070
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8175
Country	:	US
Telephone Number	:	614-305-3955
Fax Number	:	614-305-3955

Provider Business Practice Location Address
First Line	:	4144 BUCKEYE PKWY
Second Line	:	TARGET STORE NUMBER T-2070
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8175
Country	:	US
Telephone Number	:	614-305-3955
Fax Number	:	614-305-3955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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