Healthcare Provider Details

I. General information

NPI: 1235563792
Provider Name (Legal Business Name): PETER RYBA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 SAN MATEO BLVD NE
ALBUQUERQUE NM
87113-2237
US

IV. Provider business mailing address

9521 SAN MATEO BLVD NE
ALBUQUERQUE NM
87113-2237
US

V. Phone/Fax

Practice location:
  • Phone: 505-923-5500
  • Fax:
Mailing address:
  • Phone: 505-923-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007997
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: