Provider Demographics
NPI:1538441217
Name:RYAN, LISA ANN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:100 OLD ORCHARD SQ
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8172
Mailing Address - Country:US
Mailing Address - Phone:706-635-1479
Mailing Address - Fax:
Practice Address - Street 1:100 OLD ORCHARD SQ
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8172
Practice Address - Country:US
Practice Address - Phone:706-635-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist