Provider Demographics
NPI:1851656805
Name:RATNIKOVA, IRINA (RPH)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:RATNIKOVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11665 ASPEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-5274
Mailing Address - Country:US
Mailing Address - Phone:858-774-2164
Mailing Address - Fax:
Practice Address - Street 1:15721 BERNARDO HEIGHTS PKWY
Practice Address - Street 2:STE.L
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3176
Practice Address - Country:US
Practice Address - Phone:858-451-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 52462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist