Healthcare Provider Details

I. General information

NPI: 1073134532
Provider Name (Legal Business Name): RYAN VASQUEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26882 TOWNE CENTRE DR FL 1
FOOTHILL RANCH CA
92610-2862
US

IV. Provider business mailing address

26882 TOWNE CENTRE DR FL 1
FOOTHILL RANCH CA
92610-2862
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-2000
  • Fax: 949-455-8538
Mailing address:
  • Phone: 800-922-2000
  • Fax: 949-455-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: