Provider Demographics
NPI:1366859076
Name:RYAN, COURTNEY DANIELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9567
Mailing Address - Country:US
Mailing Address - Phone:812-542-3810
Mailing Address - Fax:
Practice Address - Street 1:4222 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9567
Practice Address - Country:US
Practice Address - Phone:812-542-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025517A183500000X
KY017077183500000X
OHRPH.03234130-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist