Provider Demographics
NPI:1376023085
Name:GHARAJEH, RYAN RASHEED
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RASHEED
Last Name:GHARAJEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73159
Mailing Address - Country:US
Mailing Address - Phone:405-692-1882
Mailing Address - Fax:
Practice Address - Street 1:9011 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-692-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist