Provider Demographics
NPI:1770062648
Name:COTTEN, RYAN LEWIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEWIS
Last Name:COTTEN
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 1:1379 19TH AVE # A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1811
Mailing Address - Country:US
Mailing Address - Phone:612-401-3313
Mailing Address - Fax:
Practice Address - Street 1:1379 19TH AVE # A
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1811
Practice Address - Country:US
Practice Address - Phone:612-401-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist