Healthcare Provider Details

I. General information

NPI: 1629441050
Provider Name (Legal Business Name): RYAN CHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 E BIDWELL ST
FOLSOM CA
95630-3119
US

IV. Provider business mailing address

197 WESTBURY CIR
FOLSOM CA
95630-6857
US

V. Phone/Fax

Practice location:
  • Phone: 916-984-7749
  • Fax:
Mailing address:
  • Phone: 916-983-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: