Provider Demographics
NPI:1881041812
Name:TAKETOMO, RYAN TAKESHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TAKESHI
Last Name:TAKETOMO
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 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-972-1194
Mailing Address - Fax:
Practice Address - Street 1:3800 SUMMITVIEW AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2715
Practice Address - Country:US
Practice Address - Phone:509-972-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60571229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist