Provider Demographics
NPI:1437424678
Name:KOCA, RYAN CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:KOCA
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 1:11262 CAMPUS ST
Mailing Address - Street 2:WEST HALL, B109
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3204
Mailing Address - Country:US
Mailing Address - Phone:312-927-2677
Mailing Address - Fax:
Practice Address - Street 1:11 TENNESSEE ST
Practice Address - Street 2:UNIT #180
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5420
Practice Address - Country:US
Practice Address - Phone:312-927-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist