Healthcare Provider Details

I. General information

NPI: 1275355018
Provider Name (Legal Business Name): RYAN MEJIA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

IV. Provider business mailing address

3807 AUTUMN FERN TER
SARASOTA FL
34243-3768
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-3131
  • Fax:
Mailing address:
  • Phone: 786-385-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49559
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: