Healthcare Provider Details

I. General information

NPI: 1669474680
Provider Name (Legal Business Name): RYAN JAMES GATES PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W MINERAL KING AVE INPATIENT PHARMACY
VISALIA CA
93291-6237
US

IV. Provider business mailing address

400 W MINERAL KING AVE INPATIENT PHARMACY
VISALIA CA
93291-6237
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-5647
  • Fax: 559-713-2442
Mailing address:
  • Phone: 559-624-5647
  • Fax: 559-713-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56260
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number56260
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH 56260
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH 56260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: