Provider Demographics
NPI:1376830919
Name:BRODMAN, RYAN DAVID (PHARMD)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DAVID
Last Name:BRODMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8943
Mailing Address - Country:US
Mailing Address - Phone:419-310-9793
Mailing Address - Fax:
Practice Address - Street 1:1165 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8943
Practice Address - Country:US
Practice Address - Phone:419-310-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist