Provider Demographics
NPI:1578709820
Name:RACINO, RYAN DAVID (PHARMD, AAHIVP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAVID
Last Name:RACINO
Suffix:
Gender:M
Credentials:PHARMD, AAHIVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 IOWA ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-6906
Mailing Address - Country:US
Mailing Address - Phone:215-870-6512
Mailing Address - Fax:
Practice Address - Street 1:4145 IOWA ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-6906
Practice Address - Country:US
Practice Address - Phone:619-577-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441871183500000X
CA63651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist