Provider Demographics
NPI:1083079305
Name:BASA, RYAN RENE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:RENE
Last Name:BASA
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 1:6700 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2624
Mailing Address - Country:US
Mailing Address - Phone:818-746-9923
Mailing Address - Fax:
Practice Address - Street 1:6700 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2624
Practice Address - Country:US
Practice Address - Phone:818-746-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist