Colin Francis Rybak, RPH
Individual provider Active NPI Pharmacist · Tully, NY
NPI 1578053583 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1578053583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- I062555 (NY)
- Practice address
- 596 U.S. RT 11
Tully, NY 13159 - Phone
- (315) 696-8796
- NPI assigned
- May 15, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I062555 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| KPH Healthcare Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | I062555 | NY | Yes |
Addresses
Primary practice location
596 U.S. RT 11
Tully, NY 13159
Mailing address
29 East Main Street
Gouveneur, NY 13642
Phone (315) 287-3600
Other providers in Tully, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.