Provider Demographics
NPI:1629355201
Name:ANDERSON, RYAN PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:PATRICK
Last Name:ANDERSON
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 1:9305 MISSION GORGE RD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3815
Mailing Address - Country:US
Mailing Address - Phone:619-258-8011
Mailing Address - Fax:619-258-8026
Practice Address - Street 1:9305 MISSION GORGE RD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3815
Practice Address - Country:US
Practice Address - Phone:619-258-8011
Practice Address - Fax:619-258-8026
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist