Healthcare Provider Details

I. General information

NPI: 1851834022
Provider Name (Legal Business Name): RYAN RAYMOND GRIES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-8704
  • Fax: 602-344-6556
Mailing address:
  • Phone: 602-344-8704
  • Fax: 602-344-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS020646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: