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Individual

ETHAN RYBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
24760 HOSPITAL RD, RED LAKE, MN 56671
(218) 679-3912
Mailing address
415 LAKE SHORE DR NE APT 101, BEMIDJI, MN 56601-4682
(320) 522-2591

Taxonomy

Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH6116
ND

Other

Enumeration date
06/17/2019
Last updated
06/17/2019
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