Provider Demographics
NPI:1275256174
Name:DEGUZMAN, RYAN ANTHONY SAMAR (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN ANTHONY
Middle Name:SAMAR
Last Name:DEGUZMAN
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 1:7 SILVERTHORN CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7926
Mailing Address - Country:US
Mailing Address - Phone:571-295-2367
Mailing Address - Fax:
Practice Address - Street 1:14050 WORTH AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4121
Practice Address - Country:US
Practice Address - Phone:703-492-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist