MEDICARE: GEORGE RYAN FAHNER PHARM.D

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	03326844	OH

General Provider Information

NPI Number	:	1841886983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE RYAN FAHNER PHARM.D

Provider Business Mailing Address
First Line	:	900 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1908
Country	:	US
Telephone Number	:	740-397-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1908
Country	:	US
Telephone Number	:	740-397-5505
Fax Number	:

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

Provider Enumeration Date	:	12/14/2020
Last Update Date	:	12/14/2020

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