1518465947 NPI number — CORY RYHAL PHARM D

Table of content: CORY RYHAL PHARM D (NPI 1518465947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518465947 NPI number — CORY RYHAL PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYHAL
Provider First Name:
CORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518465947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2628 SAINT CHRISTOPHER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19148-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-720-4360
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 E EVESHAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUNNEMEDE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08078-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-939-9107
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RI03887300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: RP451760 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28RJ07380 . This is a "NEW JERSEY BOARD OF PHARMACY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: RP451760 . This is a "PENNSYLVANIA BOARD OF PHARMACY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: RPI011650 . This is a "PENNSYLVANIA BOARD OF PHARMACY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 28RI03887300 . This is a "NEW JERSEY BOARD OF PHARMACY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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