Provider Demographics
NPI:1326248311
Name:OBREGON, RYAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:OBREGON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-681-8778
Mailing Address - Fax:702-650-0615
Practice Address - Street 1:1739 S BEVERLY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-8640
Practice Address - Country:US
Practice Address - Phone:928-681-8778
Practice Address - Fax:928-681-8779
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15925183500000X
AZS026464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist