Healthcare Provider Details

I. General information

NPI: 1437424678
Provider Name (Legal Business Name): RYAN CHRISTOPHER KOCA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TENNESSEE ST UNIT #180
REDLANDS CA
92373-5420
US

IV. Provider business mailing address

11262 CAMPUS ST WEST HALL, B109
LOMA LINDA CA
92354-3204
US

V. Phone/Fax

Practice location:
  • Phone: 312-927-2677
  • Fax:
Mailing address:
  • Phone: 312-927-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number64912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: