Provider Demographics
NPI:1104037548
Name:RYAN'S PHARMACY
Entity Type:Organization
Organization Name:RYAN'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBREGON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:323-707-6707
Mailing Address - Street 1:150 E HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-650-0445
Mailing Address - Fax:702-650-0615
Practice Address - Street 1:150 E HARMON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-4533
Practice Address - Country:US
Practice Address - Phone:702-650-0445
Practice Address - Fax:702-650-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15925183500000X
NVPH022393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty