Healthcare Provider Details

I. General information

NPI: 1306073424
Provider Name (Legal Business Name): JOHN RYAN MCGRATH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/25/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377TH MEDICAL GROUP 1501 SAN PEDRO ST BLDG 47
ALBUQUERQUE NM
87117-2512
US

IV. Provider business mailing address

7901 GIBSON BLVD BLDG 20176
ALBUQUERQUE NM
87117-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-846-3133
  • Fax:
Mailing address:
  • Phone: 58-463-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: