Provider Demographics
NPI:1750543302
Name:TECIA RYAN, PHARM.D.
Entity type:Organization
Organization Name:TECIA RYAN, PHARM.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, SOLE STOCKHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:TECIA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:510-385-5094
Mailing Address - Street 1:2515 MILVIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2605
Mailing Address - Country:US
Mailing Address - Phone:510-385-5094
Mailing Address - Fax:510-981-1678
Practice Address - Street 1:2515 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2605
Practice Address - Country:US
Practice Address - Phone:510-385-5094
Practice Address - Fax:510-981-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272611835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty