Healthcare Provider Details

I. General information

NPI: 1417871732
Provider Name (Legal Business Name): RYAN RAAD PETROS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 PEBBLE PL
EL CAJON CA
92019-3421
US

IV. Provider business mailing address

817 PEBBLE PL
EL CAJON CA
92019-3421
US

V. Phone/Fax

Practice location:
  • Phone: 619-414-9707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: