Provider Demographics
NPI:1184441958
Name:URENA, RYAN MARCUS (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MARCUS
Last Name:URENA
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 1:18 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-6702
Mailing Address - Country:US
Mailing Address - Phone:718-915-2788
Mailing Address - Fax:
Practice Address - Street 1:411 KING ST
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3543
Practice Address - Country:US
Practice Address - Phone:914-861-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist