MEDICARE: ALEXANDRA RYAN 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	RP449521	PA

General Provider Information

NPI Number	:	1790166056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA RYAN PHARMD

Provider Business Mailing Address
First Line	:	6039 NATIONAL PIKE
Second Line	:
City	:	GRINDSTONE
State	:	PA
Zip	:	15442-1107
Country	:	US
Telephone Number	:	724-785-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	4185 WASHINGTON RD
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2522
Country	:	US
Telephone Number	:	724-942-9111
Fax Number	:

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

Provider Enumeration Date	:	06/12/2015
Last Update Date	:	08/23/2016

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