Healthcare Provider Details

I. General information

NPI: 1063554574
Provider Name (Legal Business Name): RYAN M DARTEZ R.PH., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 JEFFERSON ST
LAFAYETTE LA
70501-6905
US

IV. Provider business mailing address

332 MILL POND DR
YOUNGSVILLE LA
70592-5655
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-4578
  • Fax: 337-235-4570
Mailing address:
  • Phone: 337-278-3007
  • Fax: 337-235-4570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15874
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: