Provider Demographics
NPI:1861097669
Name:RYAN, JEFFREY (PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:PHARM D, RPH
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1314 S BAY ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-5551
Mailing Address - Country:US
Mailing Address - Phone:352-357-6699
Mailing Address - Fax:
Practice Address - Street 1:45549 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-4519
Practice Address - Country:US
Practice Address - Phone:863-420-6120
Practice Address - Fax:863-420-6112
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59410183500000X
CTPCT.0010427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist