Individual
AMANDA RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2851 UNIVERSITY AVE, GREEN BAY, WI 54311-5855
(716) 440-4117
Mailing address
97 PROMENADE LN, WILLIAMSVILLE, NY 14221-1924
(716) 440-4117
Taxonomy
Speciality
Code
Description
License number
State
261QV0200X
VA Clinic/Center
Primary
060491
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060491
NEW YORK STATE PHARMACIST LICENSE NUMBER
NY
Enumeration date
07/07/2015
Last updated
07/07/2015
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