Healthcare Provider Details

I. General information

NPI: 1265228365
Provider Name (Legal Business Name): RYAN PUANGRAJ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

7751 MELITA AVE
NORTH HOLLYWOOD CA
91605-1818
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-7220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number85630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: